PACIFIC NORTHWEST PLASTIC SURGERY, PS (NPI# 1205951910) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205951910 |
| Entity Type | Organization |
| Organization Name | PACIFIC NORTHWEST PLASTIC SURGERY, PS |
| Practice Address |
5016 Bridgeport Way W Suite A University Place WA 98467-2039 |
| Practice Telephone | 2537619515 |
| Practice Fax Number | 2537611306 |
| Mailing Telephone | 2537619515 |
| Mailing Fax Number | 2537611306 |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2012-01-18 |
| Authorized Official Name | DR. ROSS MAGLAQUE REALICA (PRESIDENT) |
| Authorized Official Telephone | 2537619515 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 37332 | WA | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 1107846 | 05 |
| Street Address |
5016 BRIDGEPORT WAY W SUITE A |
| City | UNIVERSITY PLACE |
| State | WA |
| Zip Code | 98467-2039 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689218927 | Juliette Gallardo-zamora | Behavioral Analyst | 5915 Orchard St. W, Tacoma, WA 98467 | 2019-10-30 |
| 1306310925 | Nancy Rubi Rosas Rodriguez | Counselor | 5915 Orchard St W., Tacoma, WA 98467 | 2019-01-16 |
| 1801309091 | Penny L Crawford | Registered Nurse | 5424 57th Ave Ct. W., G8, University Place, WA 98467 | 2017-11-09 |
| 1316465578 | C.f. Bridgeport, LLC | Assisted Living Facility | 5250 Bridgeport Way W., University Place, WA 98467 | 2017-09-07 |
| 1265950422 | University Place Rehabilitation Center, LLC | Skilled Nursing Facility | 5520 Bridgeport Way W., University Place, WA 98467 | 2017-09-07 |
| 1689127037 | Rachel Ann Cruz | Counselor | 5915 Orcahrd St W, Tacoma, WA 98467 | 2016-08-02 |
| 1396099313 | Ryan Jack Holbrook | Massage Therapist | 6915 Lakewood Dr W Unit A2, Tacoma, WA 98467 | 2012-10-29 |
| 1740519701 | Laura Jean Hubert | Physical Therapist | 5520 Bridgeport Way, University Place, WA 98467 | 2009-12-21 |
| 1437395548 | Karen Marie Noyes | Occupational Therapy Assistant | 5520 Bridgeport Way West, University Place, WA 98467 | 2008-12-18 |
| 1770751083 | Orchard Medical Clinic | Internal Medicine | 5320 Orchard St W, University Place, WA 98467 | 2008-02-20 |
| Find all providers in zip 98467 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710500814 | Foundation Speech Language Learning | Specialist | 7406 27th St W Ste 24a, University Place, WA 98466-4636 | 2020-05-22 |
| 1427474980 | Tammy Lynne Gagnon | Specialist | 8425 40th St W, University Place, WA 98466-2041 | 2014-03-07 |
| 1417283557 | Lisa Ann Kingsley | Specialist | 7321 58th Street Ct W, #303, University Place, WA 98467-4723 | 2009-10-24 |
| 1750514832 | Ashley Elynn Elmer | Specialist | 8313 29th St W, Apt. C, University Place, WA 98466-2706 | 2009-08-24 |
| 1558590521 | Rachel Antonina Iacobazzi Riecan | Specialist | 8514 49th St W, University Place, WA 98467-1810 | 2009-07-10 |
| 1629266499 | Todd D Valentine | Specialist | 4009 Bridgeport Way W, Suite E-2, University Place, WA 98466-4326 | 2007-10-05 |
| 1114066990 | Renee Charise Probst | Specialist | 4103 Bridgeport Way W Ste C, University Place, WA 98466-4332 | 2007-02-06 |
| 1922147016 | Bruce Edward Corns | Specialist | 4113 Bridgeport Way W Ste B, University Place, WA 98466-4325 | 2007-02-05 |
| 1942363619 | Sara Sloan Campbell | Specialist | 8404 27th St W, University Place, WA 98466-2723 | 2006-12-17 |
| 1932110681 | David D Bluhm | Specialist | 9801 52nd St W, Unit D, University Place, WA 98467-1259 | 2006-08-10 |
| Find all providers in UNIVERSITY PLACE | ||||
| City | UNIVERSITY PLACE |
| Zip Code | 98467 |
Please comment or provide details below to improve the information on PACIFIC NORTHWEST PLASTIC SURGERY, PS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.