Basic Information
| Provider Information | |||||||||
| NPI: | 1003202870 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VENKITAPATHY | ||||||||
| FirstName: | PADHMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 LIND AVE SW | ||||||||
| Address2: | SUITE 100 ATTN CREDENTIALING | ||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980574970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256902715 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10555 SE CARR RD | ||||||||
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| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256903510 | ||||||||
| FaxNumber: | 4256909510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2015 | ||||||||
| LastUpdateDate: | 09/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | PO60841435 | WA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.