Provider Demographics
NPI:1831387489
Name:YAKIMA VALLEY DERMATOLOGY INC PS
Entity type:Organization
Organization Name:YAKIMA VALLEY DERMATOLOGY INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIOLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:BSB/ACC, CPC
Authorized Official - Phone:509-965-1714
Mailing Address - Street 1:3911 CASTLEVALE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7807
Mailing Address - Country:US
Mailing Address - Phone:509-966-7899
Mailing Address - Fax:509-965-1714
Practice Address - Street 1:3911 CASTLEVALE RD STE 301
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7807
Practice Address - Country:US
Practice Address - Phone:509-966-7899
Practice Address - Fax:509-965-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP67565Medicare UPIN