Provider Demographics
NPI:1316687908
Name:PALLER-MOORE, MACKENZIE RAMOS (MD)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:RAMOS
Last Name:PALLER-MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:RAMOS
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1959 NE PACIFIC ST # 356465
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:253-579-4295
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST # 356465
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:253-579-4295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML61289291390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program