Individual
GRACE B. GAMPONIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4033 TALBOT RD S, SUITE 570, RENTON, WA 98055-5772
(425) 656-5400
(425) 656-5079
Mailing address
3600 LIND AVE SW, SUITE 100 ATTN CREDENTIALING, RENTON, WA 98057-4970
(425) 690-2715
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
MD00035568
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043099
—
WA
05
—
8227522
—
WA
01
—
G8891427
MEDICARE - VALLEY MEDICAL GROUP
WA
Enumeration date
06/30/2006
Last updated
03/05/2020
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