Provider Demographics
NPI:1902820095
Name:TRAVAGLINI, JOHN J II (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:TRAVAGLINI
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 749730
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-9730
Mailing Address - Country:US
Mailing Address - Phone:206-971-0034
Mailing Address - Fax:206-215-4351
Practice Address - Street 1:400 SOUTH 43RD
Practice Address - Street 2:C/O VALLEY RADIATION ONCOLOGY
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055
Practice Address - Country:US
Practice Address - Phone:425-251-5121
Practice Address - Fax:425-656-4072
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000200382085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1019648Medicaid
WAAB19416Medicare PIN
WA8808517Medicare PIN
WAA06147Medicare UPIN