Healthcare Provider Details

I. General information

NPI: 1679370217
Provider Name (Legal Business Name): TREJAUN CEMAL WHITE MA60689769
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2025
Last Update Date: 03/01/2025
Certification Date: 03/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 CLAREMONT AVE S
SEATTLE WA
98144-6815
US

IV. Provider business mailing address

1216 MARTIN LUTHER KING JR WAY APT 204
TACOMA WA
98405
US

V. Phone/Fax

Practice location:
  • Phone: 206-725-0747
  • Fax:
Mailing address:
  • Phone: 253-888-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60689769
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: