| Organization Name: | PACIFIC NORTHWEST PLASTIC SURGERY, PS |
| NPI Number: | 1205951910 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROSS MAGLAQUE REALICA (PRESIDENT) |
| Mailing Address: | 5016 Bridgeport Way W Suite A University Place |
| State: | WA US |
| Postal Code: | 984672039 |
| Phone Number: | 2537619515 |
| Fax Number: | 2537611306 |
| NPI Enumeration Date: | 03/20/2007 |
| NPI Last Update Date: | 01/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 37332 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |