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General NPI Number Information
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NPI Number | 1457157133
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Entity Type | Individual
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Provider Name | MARK ANTHONY FORTES BAAS CDRT(WA-CERT)
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Gender | Male
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Dates
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Enumeration Date | 02/22/2025
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Last Update Date | 02/22/2025
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Provider Practice Location Address
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Address Line | 1519 3RD ST SE STE 102
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City | PUYALLUP
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State | WA
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Zip | 98372-3742
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Country | US
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Telephone | 253-841-0705
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Fax |
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Provider Business Mailing Address
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Address Line | 16302 66TH AVE E
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City | PUYALLUP
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State | WA
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Zip | 98375-9025
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Country | US
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Telephone | 253-355-9486
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471C3402X
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Taxonomy Name | Radiography Radiologic Technologist
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License Number | RT61618487
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License Number State | WA
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