Provider Demographics
NPI:1639109036
Name:PROANO, PABLO R (MD)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:R
Last Name:PROANO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:C/O VALLEY WEST BEHAVIORAL HEALTH BILLING SVC
Mailing Address - Street 2:17719 PACIFIC AVE S. PMB #431
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8334
Mailing Address - Country:US
Mailing Address - Phone:253-847-9195
Mailing Address - Fax:253-847-9292
Practice Address - Street 1:NORDSTROM MEDICAL TOWER
Practice Address - Street 2:1229 MADISON ST. STE.#1210
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:253-847-9195
Practice Address - Fax:253-847-9292
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA202432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1030220Medicaid
WAA14902Medicare UPIN