Organization
SOUTHGATE MEDICAL CLINIC, P.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERTO A VELASCO JR. M.D. (MEDICAL PROVIDER/OWNER)
(206) 723-9853
Entity
Organization
Contact information
Practice address
6044 MARTIN LUTHER KING JR WAY S STE 104, SEATTLE, WA 98118-3179
(206) 723-9853
(206) 723-0849
Mailing address
6044 MARTIN LUTHER KING JR WAY S STE 104, SEATTLE, WA 98118-3179
(206) 723-9853
(206) 723-0849
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD00022120
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7033046
—
WA
01
—
VE4004
REGENCE
WA
Enumeration date
08/20/2006
Last updated
08/22/2020
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