| Mystique Healthcare | |
|
11541 6th Ave E Tacoma WA 98445-8083 | |
| (206) 422-9443 | |
| Not Available |
| Full Name | Mystique Healthcare |
|---|---|
| Speciality | Clinic/Center |
| Location | 11541 6th Ave E, Tacoma, Washington |
| Authorized Official Name and Position | Luis Armando Lemus (CEO) |
| Authorized Official Contact | 2064229443 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mystique Healthcare 11541 6th Ave E Tacoma WA 98445-8083 Ph: (206) 422-9443 | Mystique Healthcare 11541 6th Ave E Tacoma WA 98445-8083 Ph: (206) 422-9443 |
| NPI Number | 1225879836 |
|---|---|
| Provider Enumeration Date | 06/06/2024 |
| Last Update Date | 11/21/2024 |
| Certification Date | 11/21/2024 |
| Medicare PECOS PAC ID | 1850812579 |
|---|---|
| Medicare Enrollment ID | O20250310002854 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225879836 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Luis Armando Lemus Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851977706 PECOS PAC ID: 2567909237 Enrollment ID: I20240731002263 |
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