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NPI Code Detail

MEDICARE: MR. RICHARD REX MARIN CPO

MEDICARE: MR. RICHARD REX MARIN CPO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Z00000XOrthotistOI60560917WA
2224P00000XProsthetistPS60560910WA

General Provider Information

NPI Number : 1336612753
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICHARD REX MARIN CPO
Provider Business Mailing Address
First Line : 723 MARTIN LUTHER KING JR WAY
Second Line :
City : TACOMA
State : WA
Zip : 98405-4139
Country : US
Telephone Number : 253-383-4447
Fax Number : 253-383-7574
Provider Business Practice Location Address
First Line : 723 MARTIN LUTHER KING JR WAY
Second Line :
City : TACOMA
State : WA
Zip : 98405-4139
Country : US
Telephone Number : 253-383-4447
Fax Number : 253-383-7574
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2019
Last Update Date : 01/08/2019

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