Healthcare Provider Details

I. General information

NPI: 1124643770
Provider Name (Legal Business Name): MARISOL SANCHEZ PC 60355053
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARISOL SANCHEZ MY SELF

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8807 EMERSON PL
EVERETT WA
98208-1947
US

IV. Provider business mailing address

8807 EMERSON PL
EVERETT WA
98208-1947
US

V. Phone/Fax

Practice location:
  • Phone: 206-356-6529
  • Fax:
Mailing address:
  • Phone: 206-356-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number604605339
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: