Individual
SAMUEL WAITHAKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5702 99TH STREET CT E, PUYALLUP, WA 98373-1082
(253) 434-6821
Mailing address
5702 99TH STREET CT E, PUYALLUP, WA 98373-1082
(253) 434-6821
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
D14093C
WA
Other
Enumeration date
10/05/2023
Last updated
10/05/2023
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