Provider Demographics
NPI:1851320188
Name:CATALINA, THOMAS S (PA C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:S
Last Name:CATALINA
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:1415 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4126
Practice Address - Country:US
Practice Address - Phone:360-424-4111
Practice Address - Fax:360-428-2458
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003865207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1112CAOtherBSWA
WA8356669Medicaid
WA0141738OtherLIWA
WA7543CAOtherBSWA
WAUS7571674OtherAETNA PCP PIN VM
WA0141737OtherLIWA
WA1805CAOtherBSWA
WA5486CAOtherBLUE SHIELD VM
WA7543CAOtherLIWA
WAP00283492OtherRAILROAD MC VM
WAG8855227Medicare PIN
WA8855997Medicare PIN
WA1112CAOtherBSWA
WAG8851498Medicare PIN
WAG8851497Medicare PIN