Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD00030038 | WA |
N | 111NI0900X | Internist | MD00030038 | WA |
Y | 207RI0200X | Infectious Disease | MD00030038 | WA |
NPI | 1073519328 |
---|---|
Provider Name | Dr. Albert Dominick Pacifico II |
First Address | Portland, OR 97208-3360 |
Second Address | Everett, WA 98201-1665 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 22/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1042731 | (05) | WA |
8150468 | (05) | WA |
F58145 | (02) | WA |