Healthcare Provider Details

I. General information

NPI: 1083579528
Provider Name (Legal Business Name): SULE MARTINEZ-DEBATE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 N 35TH ST
TACOMA WA
98407-6033
US

IV. Provider business mailing address

9231 S 198TH ST
RENTON WA
98055-4111
US

V. Phone/Fax

Practice location:
  • Phone: 206-580-6940
  • Fax:
Mailing address:
  • Phone: 206-429-1984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: