Individual
MS. SUJATHA MANTHINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
400 S 43RD ST, RENTON, WA 98055-5714
(425) 228-3440
(425) 656-4214
Mailing address
3600 LIND AVE SW, SUITE 100 ATTN CREDENTIALING, RENTON, WA 98057
(425) 690-2715
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD60620629
WA
208M00000X
Hospitalist Physician
061984
GA
208M00000X
Hospitalist Physician
Primary
MD60620629
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2050708
—
WA
Enumeration date
04/21/2009
Last updated
09/30/2019
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