Healthcare Provider Details

I. General information

NPI: 1356660930
Provider Name (Legal Business Name): JOSEPH LEONARDO MARIN RT (R) (MRI)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2010
Last Update Date: 05/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FITZSIMMONS DR BLDG 9040
TACOMA WA
98431-0001
US

IV. Provider business mailing address

8546 FORTMAN DR NE
LACEY WA
98516-6297
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-0715
  • Fax:
Mailing address:
  • Phone: 360-489-1146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number421328
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number421328
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: