Healthcare Provider Details

I. General information

NPI: 1730018896
Provider Name (Legal Business Name): MARNEL RAMIREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10712 SE CARR RD
RENTON WA
98055-5826
US

IV. Provider business mailing address

10323 SE 186TH ST
RENTON WA
98055-8429
US

V. Phone/Fax

Practice location:
  • Phone: 206-922-9173
  • Fax:
Mailing address:
  • Phone: 206-922-9173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPHAI.IR.61183261
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: