Provider Demographics
NPI:1598758484
Name:IREGUI, MANUEL GUILLERMO (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:GUILLERMO
Last Name:IREGUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 YAKIMA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5307
Mailing Address - Country:US
Mailing Address - Phone:253-572-5140
Mailing Address - Fax:253-272-0419
Practice Address - Street 1:1708 YAKIMA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5307
Practice Address - Country:US
Practice Address - Phone:253-572-5140
Practice Address - Fax:253-272-0419
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA41593207R00000X, 207RC0200X, 207RP1001X
IN01082171A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8317380Medicaid
WA110241336OtherRR MEDICARE
WAG95139Medicare UPIN
WAGAB32942-PIERCE COMedicare PIN
WA8317380Medicaid