Individual
VICTOR MANUEL HERNANDES PINEDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9537 GRAVELLY LAKE DR SW, LAKEWOOD, WA 98499-1513
(253) 984-2000
(253) 815-9797
Mailing address
9537 GRAVELLY LAKE DR SW, LAKEWOOD, WA 98499-1513
(253) 984-2000
(253) 815-9797
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA61012242
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2147900
—
WA
Enumeration date
08/28/2018
Last updated
12/04/2020
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