Healthcare Provider Details

I. General information

NPI: 1518565332
Provider Name (Legal Business Name): ANGELICA MARIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
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: 360-333-2409
  • Fax:
Mailing address:
  • Phone: 360-420-8770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61592168
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number604278662
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: