Organization
PIERCE COUNTY JAIL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIGUEL BALDERRAMA (JAIL MEDICAL DIRECTOR)
(253) 798-7402
Entity
Organization
Contact information
Practice address
910 TACOMA AVE S, TACOMA, WA 98402-2104
(253) 798-3442
(253) 798-4043
Mailing address
910 TACOMA AVE S, TACOMA, WA 98402-2104
(253) 798-3442
(253) 798-4043
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10001047
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8476145
—
WA
01
—
PA10001047
PA LICENSE
WA
Enumeration date
03/25/2010
Last updated
03/25/2010
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