Healthcare Provider Details

I. General information

NPI: 1508951864
Provider Name (Legal Business Name): TINA MARINA PASSALARIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 N 5TH AVE
SEQUIM WA
98382-3045
US

IV. Provider business mailing address

844 N 5TH AVE
SEQUIM WA
98382-3045
US

V. Phone/Fax

Practice location:
  • Phone: 360-683-9895
  • Fax: 360-582-2820
Mailing address:
  • Phone: 360-683-9895
  • Fax: 360-582-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD00032741
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: