Provider Demographics
NPI:1821400029
Name:TADEO, DANILO VITENTE (MD, MLS(ASCP)CM)
Entity type:Individual
Prefix:DR
First Name:DANILO
Middle Name:VITENTE
Last Name:TADEO
Suffix:
Gender:M
Credentials:MD, MLS(ASCP)CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5299
Mailing Address - Street 2:MS: 820-5-PCO
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0299
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17700 SE 272ND ST # 440
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4951
Practice Address - Country:US
Practice Address - Phone:253-372-7155
Practice Address - Fax:253-372-7071
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC7-0006657208000000X
PAMT213601208000000X
WAMD61521956208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics