Provider Demographics
NPI:1689919292
Name:POMA FERTILITY, LLC
Entity Type:Organization
Organization Name:POMA FERTILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:OPSAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-822-7662
Mailing Address - Street 1:12039 NE 128TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3030
Mailing Address - Country:US
Mailing Address - Phone:425-822-7662
Mailing Address - Fax:425-822-0172
Practice Address - Street 1:12039 NE 128TH ST STE 110
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3030
Practice Address - Country:US
Practice Address - Phone:425-822-7662
Practice Address - Fax:425-822-0172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00004391261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty