P.C. Jail Clinic

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

Legal business name

P.C. JAIL CLINIC

Practice address

910 Tacoma Ave S
Tacoma, WA 98402-2104

Phone

(253) 798-4033

Fax

(253) 798-4043

NPI assigned

Jan 19, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Miguel Balderrama, M.D.

Title

Medical Director

Phone

(253) 798-4033

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699828103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 TACOMA AVE S",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984022104",
            "telephone_number": "253-798-4033",
            "fax_number": "253-798-4043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 TACOMA AVE S",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984022104",
            "telephone_number": "253-798-4033",
            "fax_number": "253-798-4043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P.C. JAIL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BALDERRAMA",
        "authorized_official_first_name": "MIGUEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "253-798-4033",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "MD00034248",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Galinah Oyombra
• John David Ozimkowski
• Devrim Ozkan
• Arthur J Ozolin, MD
• Cierra A Ozolin, PH.D., LICSW, SUDPT
• Heather S Paar, CNM, ARNP
• Carmen Leilani Pablo
• Jessica Lynn Pabst, MSW, LICSW
• Pace Dermatology Associates, PLLC
• Aaron Pace, M.D.

• Custodial Care Facility in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Custodial Care Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.