Healthcare Provider Details

I. General information

NPI: 1487573531
Provider Name (Legal Business Name): GUADALUPE HUDGENS MT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W YAKIMA AVE STE 104
YAKIMA WA
98902-3088
US

IV. Provider business mailing address

1561 BUS RD
MABTON WA
98935-9773
US

V. Phone/Fax

Practice location:
  • Phone: 509-248-4536
  • Fax: 509-236-1859
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.70146140
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: