Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | PA0001585 | WA |
NPI | 1811920010 |
---|---|
Provider Name | Mr. Cirilo P Adao |
First Address | Lakewood, WA 98499 |
Second Address | Lakewood, WA 98499-8120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 06/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1811920010 | (05) | WA |