Provider Demographics
NPI:1710607403
Name:GOOD SHEPHERD MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:GOOD SHEPHERD MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAZELINE
Authorized Official - Middle Name:VILLARUZ
Authorized Official - Last Name:GUMIRAN-ALEJANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:206-372-2960
Mailing Address - Street 1:714 S 38TH CT
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5894
Mailing Address - Country:US
Mailing Address - Phone:206-372-2960
Mailing Address - Fax:425-282-4455
Practice Address - Street 1:714 S 38TH CT
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5894
Practice Address - Country:US
Practice Address - Phone:206-372-2960
Practice Address - Fax:425-282-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty