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Organization

SOUTHWEST PORTLAND MEDICAL CLINIC INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. FELINO BAUTISTA DE LEON III MD (PRESIDENT)
(425) 306-9447
Entity
Organization

Contact information

Practice address
3716 PACIFIC AVE STE D, TACOMA, WA 98418-7836
(253) 474-7719
Mailing address
6097 156TH PL SE, BELLEVUE, WA 98006-5307
(425) 785-6164

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
00022250
WA

Other

Enumeration date
11/02/2009
Last updated
11/02/2009
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