Provider Demographics
NPI:1881173557
Name:TAMPARONG, CLYDE
Entity type:Individual
Prefix:
First Name:CLYDE
Middle Name:
Last Name:TAMPARONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 S ORCAS ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2266
Mailing Address - Country:US
Mailing Address - Phone:206-883-2113
Mailing Address - Fax:
Practice Address - Street 1:3920 S ORCAS ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2266
Practice Address - Country:US
Practice Address - Phone:206-883-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60155360163WD1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal
Provider Identifiers
StateIdentifier IDID TypeIssuer
WATAMPACA211JNOtherWASHINGTON DRIVER LICENSE