Provider Demographics
NPI:1255452058
Name:WALLA WALLA CARDIOLOGY SPECIALIST CLINIC,P.S.
Entity type:Organization
Organization Name:WALLA WALLA CARDIOLOGY SPECIALIST CLINIC,P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BESSIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:YUSTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-522-2882
Mailing Address - Street 1:1103 S 2ND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4118
Mailing Address - Country:US
Mailing Address - Phone:509-522-2882
Mailing Address - Fax:509-522-2809
Practice Address - Street 1:1103 S 2ND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4118
Practice Address - Country:US
Practice Address - Phone:509-522-2882
Practice Address - Fax:509-522-2809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty