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GRAYS HARBOR PEDIATRICS, PLLC

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Company Details

Legal Name: GRAYS HARBOR PEDIATRICS, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: December 27th 2005
Date of Dissolution: April 1st 2015
Expiration date: 31 Dec 2014
UBI Number: 602 567 819
ZIP code: 98520
City: Aberdeen
County: GRAYS HARBOR
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 1010 ANDERSON DR STE 204, ABERDEEN, WA, 98520, UNITED STATES

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Registered Agent Information

Name Role Address
HAGEN BATES & EDWARDS PS Registered Agent 110 W MARKET #202, ABERDEEN, WA, 98520, UNITED STATES

Key Officers & Management

Name Role Address
TRACY RUSSELL Governing Person 611 N F ST #201, ABERDEEN, WA, 98520, UNITED STATES
EDGARDO MAGSALAY Governing Person 611 N F ST #201, ABERDEEN, WA, 98520, UNITED STATES
RICHARD MAGSALAY EXECUTOR 1020 ANDERSON DR STE 204, ABERDEEN, WA, 98520, UNITED STATES
RICHELLE AORES EXECUTOR 1020 ANDERSON DR STE 204, ABERDEEN, WA, 98520, UNITED STATES

National Provider Identifier

NPI Number:
1104971845

Authorized Person:

Name:
EDGARDO C MAGSALAY
Role:
MEMBER
Phone:

Taxonomy:

Selected Taxonomy:
2080A0000X - Pediatric Adolescent Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
3605330470
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