Healthcare Provider Details

I. General information

NPI: 1376369769
Provider Name (Legal Business Name): MARCELO HUGO URIARTE MAYORGA MD FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

11902 45TH AVE SE
EVERETT WA
98208-9160
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2000
  • Fax:
Mailing address:
  • Phone: 425-328-8497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMDFE70056403
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: