Provider Demographics
NPI:1063878684
Name:PRIMAVITA FAMILY MEDICINE
Entity type:Organization
Organization Name:PRIMAVITA FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINSATO
Authorized Official - Suffix:
Authorized Official - Credentials:ND, EAMP
Authorized Official - Phone:425-273-0741
Mailing Address - Street 1:15446 BEL RED RD STE B15
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5507
Mailing Address - Country:US
Mailing Address - Phone:425-273-0741
Mailing Address - Fax:844-218-1125
Practice Address - Street 1:15446 BEL RED RD STE B15
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5507
Practice Address - Country:US
Practice Address - Phone:425-273-0741
Practice Address - Fax:844-218-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60071802171100000X
WANT60071822175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty