Healthcare Provider Details

I. General information

NPI: 1033037262
Provider Name (Legal Business Name): MARCO RYAN QUINTERO SUDPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S TOBIN ST STE A
RENTON WA
98057-5338
US

IV. Provider business mailing address

200 SOUTH TOBIN STREET SUIT A
RENTON WA
98057
US

V. Phone/Fax

Practice location:
  • Phone: 425-250-6500
  • Fax:
Mailing address:
  • Phone: 425-250-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: