Basic Information
| Provider Information | |||||||||
| NPI: | 1467054924 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIORENAL THERAPEUTICS OF WASHINGTON, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 PACIFIC AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984024381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1253228990 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 PACIFIC AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984024381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533008447 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2020 | ||||||||
| LastUpdateDate: | 11/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | SHAH | ||||||||
| AuthorizedOfficialFirstName: | REHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5167217069 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RN0300X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.