Basic Information
| Provider Information | |||||||||
| NPI: | 1487226411 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOMASUNDARAM | ||||||||
| FirstName: | SOUNDARYA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 PACIFIC AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984024381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533008453 | ||||||||
| FaxNumber: | 2065905919 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 PACIFIC AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984024381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533008453 | ||||||||
| FaxNumber: | 2065905919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2021 | ||||||||
| LastUpdateDate: | 07/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PABP.BG.61195408 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.