Provider Demographics
NPI:1841677655
Name:PUGET SOUND PSYCHIATRIC CENTER
Entity type:Organization
Organization Name:PUGET SOUND PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:JAMAL
Authorized Official - Last Name:MUSTAFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-806-5021
Mailing Address - Street 1:10634 E RIVERSIDE DR
Mailing Address - Street 2:STE. 130
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3757
Mailing Address - Country:US
Mailing Address - Phone:425-806-5021
Mailing Address - Fax:425-486-3949
Practice Address - Street 1:10634 E RIVERSIDE DR
Practice Address - Street 2:STE. 130
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3757
Practice Address - Country:US
Practice Address - Phone:425-806-5021
Practice Address - Fax:425-486-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATR604871062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty