Provider Demographics
NPI:1447370366
Name:PABLO R PROANO MD PS
Entity type:Organization
Organization Name:PABLO R PROANO MD PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:R
Authorized Official - Last Name:PROANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-386-3103
Mailing Address - Street 1:17719 PAC AVE S VALLEY WEST BILLING SVC
Mailing Address - Street 2:PMB 431
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8334
Mailing Address - Country:US
Mailing Address - Phone:253-847-9195
Mailing Address - Fax:253-847-9292
Practice Address - Street 1:1229 MADISON ST
Practice Address - Street 2:STE 1210
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3586
Practice Address - Country:US
Practice Address - Phone:206-386-3103
Practice Address - Fax:206-386-3123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA202432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1030220Medicaid
WA1030220Medicaid