Healthcare Provider Details

I. General information

NPI: 1720917362
Provider Name (Legal Business Name): NIKOLAS GONZALEZ-HERNANDEZ LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 N 45TH ST
SEATTLE WA
98103-6982
US

IV. Provider business mailing address

2319 N 45TH ST
SEATTLE WA
98103-6982
US

V. Phone/Fax

Practice location:
  • Phone: 360-536-4020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number70110442
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: