Southwest Portland Medical Clinic Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

00022250 Issued in WA

Legal business name

SOUTHWEST PORTLAND MEDICAL CLINIC INC

Practice address

3716 Pacific Ave Ste D
Tacoma, WA 98418-7836

Phone

(253) 474-7719

NPI assigned

Nov 2, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Felino Bautista De Leon III, MDNPI 1255433132

Title

President

Phone

(425) 306-9447

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Felino Bautista Deleon III, MD

  • General Practice Physician
  • Tacoma, WA
  • NPI 1255433132
  NPD Authorized official
• Fernando Francisco Deguzman, M.D.

  • Family Medicine Physician
  • Tacoma, WA
  • NPI 1558409441
  NPD (past)
• Maria Jelyn B Engelhardt-Parales, NP-C

  • Primary Care Nurse Practitioner
  • Tacoma, WA
  • NPI 1750046157
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257120000000",
    "number": "1245566843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6097 156TH PL SE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980065307",
            "telephone_number": "425-785-6164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3716 PACIFIC AVE STE D",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984187836",
            "telephone_number": "253-474-7719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST PORTLAND MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-02",
        "last_updated": "2009-11-02",
        "status": "A",
        "authorized_official_last_name": "DE LEON",
        "authorized_official_first_name": "FELINO",
        "authorized_official_middle_name": "BAUTISTA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "425-306-9447",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WA",
            "license": "00022250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Sound Pediatric Occupational Therapy
• South Tacoma Chiropractic and Rehabilitation, PLLC
• South Tacoma Dental LLC
• Frances Rose Southall, LMP
• Southwest Arkansas Dialysis
• Courtney Allyson Souza
• Patricia L Sowards
• SP Behavior Consulting, LLC
• Claire Leona Spain-Remy, M.D.
• Glenn Craig Spalding, LICSW

• Primary Care Clinic/Center in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Primary Care Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.