Provider Demographics
NPI:1720694821
Name:ROS, TESSAVAN (INTERPRETER)
Entity Type:Individual
Prefix:MR
First Name:TESSAVAN
Middle Name:
Last Name:ROS
Suffix:
Gender:M
Credentials:INTERPRETER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13119 DES MOINES MEMORIAL DR S
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98168-2849
Mailing Address - Country:US
Mailing Address - Phone:206-853-0458
Mailing Address - Fax:
Practice Address - Street 1:13119 DES MOINES MEMORIAL DR S
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98168-2849
Practice Address - Country:US
Practice Address - Phone:206-853-0458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0766714286743497171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty