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NPI Code Detail

MEDICARE: ICYLE YVONNE DURAN MA60591538

MEDICARE: ICYLE YVONNE DURAN MA60591538
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
1225700000XMassage TherapistMA60591538WA

General Provider Information

NPI Number : 1528435500
Entity Type Code : Individual
Provider Name (Legal Business Name) : ICYLE YVONNE DURAN MA60591538
Provider Business Mailing Address
First Line : 6053 21ST AVE SW
Second Line :
City : SEATTLE
State : WA
Zip : 98106-1419
Country : US
Telephone Number : 206-948-0352
Fax Number :
Provider Business Practice Location Address
First Line : 5236 CALIFORNIA AVE SW STE D
Second Line :
City : SEATTLE
State : WA
Zip : 98136-1283
Country : US
Telephone Number : 206-331-3999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2015
Last Update Date : 08/26/2015

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