INNOVATIVE WOUND HEALING & DERMATOLOGY PLLC

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Company Details

Legal Name:	INNOVATIVE WOUND HEALING & DERMATOLOGY PLLC
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category:	DOMESTIC ENTITY
Status:	Active
Formation/ Registration Date:	April 1st 2021
Expiration date:	30 Apr 2026
UBI Number:	604 738 523
ZIP code:	98004
City:	Bellevue
County:	KING
Home State:	WASHINGTON
Principal Office Street Address:	10047 MAIN ST STE 101, BELLEVUE, WA, 98004-5323, UNITED STATES

Contact Details

E-Mail:

SKINDOC08@GMAIL.COM

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name	Role
GREEN BUSINESS INCORPORATED	Registered Agent

Key Officers & Management

Name	Role	Address
FELIPE RIVERA	Executor	1600 116TH AVE NE STE 302, BELLEVUE, WA, 98004-3057, UNITED STATES
DANIEL LEVY	Governing Person	-

National Provider Identifier

NPI Number:

1538741053

Certification Date:

2024-09-16

Link:

View on NPI website

Authorized Person:

Name:

DANIEL LEVY

Role:

PROVIDER

Phone:

8004252805

Taxonomy:

Selected Taxonomy:

207N00000X - Dermatology Physician

Is Primary:

Yes

Contacts:

Phone:

+1 800-425-2805

Fax:

8556731403

History

Type	Old value	New value	Date of change
Name change	INNOVATIVE WOUND HEALING & DERMATOLOGY LLC	INNOVATIVE WOUND HEALING & DERMATOLOGY PLLC	2023-06-05

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