Organization
PACIFIC NORTHWEST PLASTIC SURGERY, PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROSS MAGLAQUE REALICA MD (PRESIDENT)
(253) 761-9515
Entity
Organization
Contact information
Practice address
5016 BRIDGEPORT WAY W, SUITE A, UNIVERSITY PLACE, WA 98467-2039
(253) 761-9515
(253) 761-1306
Mailing address
5016 BRIDGEPORT WAY W, SUITE A, UNIVERSITY PLACE, WA 98467-2039
(253) 761-9515
(253) 761-1306
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
37332
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1107846
—
WA
Enumeration date
03/20/2007
Last updated
01/18/2012
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