Healthcare Provider Details

I. General information

NPI: 1376465021
Provider Name (Legal Business Name): DANTE MARIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 CLEVELAND AVE
MOUNT VERNON WA
98273-4210
US

IV. Provider business mailing address

1612 N 26TH ST APT 110
MOUNT VERNON WA
98273-6427
US

V. Phone/Fax

Practice location:
  • Phone: 360-421-1451
  • Fax:
Mailing address:
  • Phone: 360-421-1451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.70053533
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: