Basic Information
| Provider Information | |||||||||
| NPI: | 1326067745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAVES | ||||||||
| FirstName: | ANITA | ||||||||
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| Credential: | MD | ||||||||
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| OtherLastName: | VELASCO | ||||||||
| OtherFirstName: | ANITA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 34935 | ||||||||
| Address2: | DEPT # 61 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981241935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064394888 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16110 8TH AVE SW | ||||||||
| Address2: | SUITE C2 | ||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981662962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062427822 | ||||||||
| FaxNumber: | 2062442133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD00018945 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.