Organization
P.C. JAIL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIGUEL BALDERRAMA M.D. (MEDICAL DIRECTOR)
(253) 798-4033
Entity
Organization
Contact information
Practice address
910 TACOMA AVE S, TACOMA, WA 98402-2104
(253) 798-4033
(253) 798-4043
Mailing address
910 TACOMA AVE S, TACOMA, WA 98402-2104
(253) 798-4033
(253) 798-4043
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD00034248
MEDICAL LICENSE
WA
Enumeration date
01/19/2007
Last updated
08/22/2020
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