Organization
INNOVATIVE CARE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FERNANDA VELDERRAIN (OFFICE MANAGER)
(425) 338-1555
Entity
Organization
Contact information
Practice address
1700 132ND ST SE, SUITE L, MILL CREEK, WA 98012-5309
(425) 338-1555
(425) 338-0765
Mailing address
1700 132ND ST SE, SUITE L, MILL CREEK, WA 98012-5309
(425) 338-1555
(425) 338-0765
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0287152
LABOR AND INDUSTRIES
WA
Enumeration date
12/09/2011
Last updated
12/09/2011
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