Healthcare Provider Details

I. General information

NPI: 1568501559
Provider Name (Legal Business Name): EMMANUEL OWEN ARSENI PICACHE MARTINEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16259 SYLVESTER RD SW STE 503
BURIEN WA
98166-3059
US

IV. Provider business mailing address

16259 SYLVESTER RD SW STE 502
BURIEN WA
98166-3059
US

V. Phone/Fax

Practice location:
  • Phone: 206-835-7440
  • Fax: 206-835-7459
Mailing address:
  • Phone: 206-835-7440
  • Fax: 206-835-7459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2006-0403
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number04-34526
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number04-34526
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number04-34526
License Number StateKS
# 5
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD60823477
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: