Healthcare Provider Details

I. General information

NPI: 1558598987
Provider Name (Legal Business Name): MARI TOKITA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST BOX 356043
SEATTLE WA
98195-6043
US

IV. Provider business mailing address

1959 NE PACIFIC ST BOX 356043
SEATTLE WA
98195-6043
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-4100
  • Fax:
Mailing address:
  • Phone: 206-598-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMDR-5719
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberML60178552
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: