Healthcare Provider Details

I. General information

NPI: 1033027289
Provider Name (Legal Business Name): MARIPOSA MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12014 SE MILL PLAIN BLVD STE 100
VANCOUVER WA
98684-4043
US

IV. Provider business mailing address

2201 NE 112TH AVE APT C29
VANCOUVER WA
98684-4205
US

V. Phone/Fax

Practice location:
  • Phone: 360-513-3853
  • Fax:
Mailing address:
  • Phone: 360-513-3853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. ALYSA ALEXJANDRA CHURAPE
Title or Position: LICENSED MASSAGE THERAPIST
Credential: MA61616873
Phone: 360-513-3853