Provider Demographics
NPI:1659554533
Name:RAINBOW PEDIATRICS, LLC
Entity Type:Organization
Organization Name:RAINBOW PEDIATRICS, LLC
Other - Org Name:THE KIDS CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOROSHOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-957-1881
Mailing Address - Street 1:12317 15TH AVE NE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125
Mailing Address - Country:US
Mailing Address - Phone:206-957-1881
Mailing Address - Fax:206-957-1895
Practice Address - Street 1:12317 15TH AVE NE
Practice Address - Street 2:SUITE 103
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4871
Practice Address - Country:US
Practice Address - Phone:206-957-1881
Practice Address - Fax:206-957-1895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020986208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4215844OtherAETNA
WA1072255Medicaid
WA6585DOOtherREGENCE
P594301OtherPREMERA
WAA09275OtherUPIN