Provider Demographics
NPI:1609813385
Name:ROSARIO SKIN CLINIC PC INC
Entity Type:Organization
Organization Name:ROSARIO SKIN CLINIC PC INC
Other - Org Name:ROSARIO SKIN CLINIIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLELT
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:360-336-3026
Mailing Address - Street 1:1600 CONTINENTAL PLACE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-5607
Mailing Address - Country:US
Mailing Address - Phone:360-336-3026
Mailing Address - Fax:
Practice Address - Street 1:1600 CONTINENTAL PLACE
Practice Address - Street 2:SUITE #101
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5607
Practice Address - Country:US
Practice Address - Phone:360-336-3026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045767261QM2500X
WAMD00046521261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP73421Medicare UPIN
WA8860479Medicare PIN
WAI37931Medicare UPIN