Provider Demographics
NPI:1750363214
Name:PROANO, FERNANDO DIEGO (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:DIEGO
Last Name:PROANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PROANO
Other - Middle Name:
Other - Last Name:ASSSOCIATES INC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10618 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-1560
Mailing Address - Country:US
Mailing Address - Phone:206-294-4197
Mailing Address - Fax:425-589-0531
Practice Address - Street 1:10618 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-1560
Practice Address - Country:US
Practice Address - Phone:206-294-4197
Practice Address - Fax:425-589-0531
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000189722083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAE72461Medicare UPIN