Provider Demographics
NPI:1558521237
Name:DIANA TATTONI
Entity Type:Organization
Organization Name:DIANA TATTONI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MARTINEZ
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-828-3626
Mailing Address - Street 1:433 STATE ST S STE 1
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6615
Mailing Address - Country:US
Mailing Address - Phone:425-828-3626
Mailing Address - Fax:425-828-3628
Practice Address - Street 1:433 STATE ST S STE 1
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6615
Practice Address - Country:US
Practice Address - Phone:425-828-3626
Practice Address - Fax:425-828-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABUS0973261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1049303Medicaid
WAA14797Medicare UPIN