SOUTHGATE MEDICAL CLINIC P.S. NPI 1336254051

NPI Information

SOUTHGATE MEDICAL CLINIC, P.S. is a primary care clinic center in Seattle, WA. SOUTHGATE MEDICAL CLINIC, P.S. NPI is 1336254051. The provider is registered as an organization entity type.

The provider's business location address is:

6044 MARTIN LUTHER KING JR WAY S STE 104
SEATTLE, WA
ZIP 98118-179
Phone: (206) 723-9853
Fax: (206) 723-0849

The provider's authorized official is Roberto A Velasco .
The authorized official title is Medical Provider/owner and has the following contact phone number (206) 723-9853.

The CLIA number assigned to this NPI record is 50D0934866 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/20/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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