Basic Information
| Provider Information | |||||||||
| NPI: | 1528383155 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE VERA | ||||||||
| FirstName: | PAOLO ANTONIO | ||||||||
| MiddleName: | DE BELEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 N 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993015257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095477704 | ||||||||
| FaxNumber: | 5095423059 | ||||||||
| Practice Location | |||||||||
| Address1: | 7425 WRIGLEY DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993015292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095468399 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2010 | ||||||||
| LastUpdateDate: | 09/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD60136192 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.