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WASHINGTON PAIN AND SPINE SPECIALISTS, LLC

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Company Details

Legal Name: WASHINGTON PAIN AND SPINE SPECIALISTS, LLC
Jurisdiction: WASHINGTON
Entity Type: WA LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: May 22nd 2023
Expiration date: 31 May 2026
UBI Number: 605 250 814
ZIP code: 98006
City: Bellevue
County: KING
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 4957 LAKEMONT BLVD SE STE C-425, BELLEVUE, WA, 98006-7801, UNITED STATES

Contact Details

E-Mail: PMAMBALAM@GMAIL.COM
Phone Number: +1 240-463-4101

Nature of Business

Any Lawful Purpose

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Registered Agent Information

Name Role Address
PRAVEEN MAMBALAM Registered Agent 4957 LAKEMONT BLVD SE STE C-425, BELLEVUE, WA, 98006-7801, UNITED STATES

Key Officers & Management

Name Role Address
LEGALLY MINE, LLC Executor 1337 E 750 N, OREM, UT, 84097-5480, UNITED STATES
PRAVEEN MAMBALAM Governing Person -

National Provider Identifier

NPI Number:
1992486906
Certification Date:
2023-07-31

Authorized Person:

Name:
DR. PRAVEEN KUMAR MAMBALAM
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QP3300X - Pain Clinic/Center
Is Primary:
Yes

Contacts:

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