Individual
BERNADETH TAGLE GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1909 214TH ST SE STE 300, BOTHELL, WA 98021-4418
(425) 412-7200
Mailing address
1909 214TH ST SE STE 300, BOTHELL, WA 98021-4418
(425) 412-7200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00047444
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1042878
—
WA
01
—
225508
L & I NUMBER
WA
05
—
8495723
—
WA
01
—
8868622
MEDICARE NUMBER
WA
Enumeration date
06/14/2006
Last updated
06/28/2023
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