Provider Demographics
NPI:1619373081
Name:MOSS BAY HEALTH CENTER
Entity Type:Organization
Organization Name:MOSS BAY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-822-2858
Mailing Address - Street 1:634 7TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033
Mailing Address - Country:US
Mailing Address - Phone:425-822-2858
Mailing Address - Fax:425-822-5611
Practice Address - Street 1:634 7TH AVE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5665
Practice Address - Country:US
Practice Address - Phone:425-822-2858
Practice Address - Fax:425-822-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABUS14775175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty