Provider Demographics
NPI:1962775486
Name:PACIFIC CLINIC & URGENT CARE PLLC
Entity type:Organization
Organization Name:PACIFIC CLINIC & URGENT CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LIZETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIMAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-592-2623
Mailing Address - Street 1:15500 1ST AVE S
Mailing Address - Street 2:SUITE 106A
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1052
Mailing Address - Country:US
Mailing Address - Phone:206-592-2623
Mailing Address - Fax:
Practice Address - Street 1:15500 1ST AVE S
Practice Address - Street 2:SUITE 106A
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1052
Practice Address - Country:US
Practice Address - Phone:206-592-2623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty