Provider Demographics
NPI:1548523756
Name:PAMINTUAN, LISA DAWN (CPT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:PAMINTUAN
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21540 30TH DR SE STE 220
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7015
Mailing Address - Country:US
Mailing Address - Phone:206-341-0646
Mailing Address - Fax:
Practice Address - Street 1:21540 30TH DR SE STE 220
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-7015
Practice Address - Country:US
Practice Address - Phone:206-341-0646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00047618183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician