Healthcare Provider Details

I. General information

NPI: 1811308893
Provider Name (Legal Business Name): MARNONETTE J MARALLAG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2671 NE 46TH ST
SEATTLE WA
98105-5041
US

IV. Provider business mailing address

PO BOX 741515
LOS ANGELES CA
90074-1515
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-8000
  • Fax: 206-525-8070
Mailing address:
  • Phone: 206-525-8000
  • Fax: 206-525-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR74527
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60829070
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60829070
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: