Provider Demographics
NPI:1649991928
Name:VINOGRADSKI, PAUL LEONID (PA-S)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:LEONID
Last Name:VINOGRADSKI
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 YAKIMA AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5304
Mailing Address - Country:US
Mailing Address - Phone:253-382-8540
Mailing Address - Fax:253-382-8545
Practice Address - Street 1:1802 YAKIMA AVE STE 204
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5304
Practice Address - Country:US
Practice Address - Phone:253-382-8540
Practice Address - Fax:253-382-8545
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61496599363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2271172Medicaid