Organization
THE IDA KARLIN PEDIATRIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OVIDIO PENALVER MD (CORPORATE OFFICER, PROVIDER)
(253) 848-0351
Entity
Organization
Contact information
Practice address
319 5TH ST SW, PUYALLUP, WA 98371-5828
(253) 848-0351
(253) 841-1397
Mailing address
319 5TH ST SW, PUYALLUP, WA 98371-5828
(253) 848-0351
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LH60394287
WA
103T00000X
Psychologist
PY60385056
WA
208000000X
Pediatrics Physician
Primary
MD00015660
WA
363LP0200X
Pediatric Nurse Practitioner
AP60312846
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP60311598
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7110653
—
WA
Enumeration date
05/14/2007
Last updated
12/23/2015
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