Healthcare Provider Details

I. General information

NPI: 1891264883
Provider Name (Legal Business Name): TASHA DELOS SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 ROY ST STE 100
SEATTLE WA
98109-4288
US

IV. Provider business mailing address

500 22ND AVE
SEATTLE WA
98122-6015
US

V. Phone/Fax

Practice location:
  • Phone: 206-285-1068
  • Fax:
Mailing address:
  • Phone: 206-484-4680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60895812
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: