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General NPI Number Information
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NPI Number | 1760279111
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Entity Type | Individual
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Provider Name | ALEX MARIO RANGEL
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Gender | Male
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 317 W LEWIS ST STE A
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City | PASCO
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State | WA
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Zip | 99301-5645
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Country | US
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Telephone | 509-906-1148
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Fax |
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Provider Business Mailing Address
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Address Line | 317 W LEWIS ST STE A
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City | PASCO
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State | WA
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Zip | 99301-5645
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Country | US
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Telephone | 509-906-1148
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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 | 122400000X
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Taxonomy Name | Denturist
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License Number | DN61459006
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License Number State | WA
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