Organization Name: | THE IDA KARLIN PEDIATRIC CENTER |
NPI Number: | 1366657918 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | OVIDIO PENALVER (CORPORATE OFFICER, PROVIDER) |
Mailing Address: | 319 5th St Sw Puyallup |
State: | WA US |
Postal Code: | 983715828 |
Phone Number: | 2538480351 |
Fax Number: | 2538411397 |
NPI Enumeration Date: | 05/14/2007 |
NPI Last Update Date: | 12/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | LH60394287 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |