Healthcare Provider Details

I. General information

NPI: 1740952399
Provider Name (Legal Business Name): TESORO YASMIN ESCALANTE MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TESORO YASMIN ESCALANTE MASSAGE THERAPIST

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10030 15TH AVE SW
SEATTLE WA
98146-3728
US

IV. Provider business mailing address

10030 15TH AVE SW
SEATTLE WA
98146-3728
US

V. Phone/Fax

Practice location:
  • Phone: 206-763-7464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number60682001
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: