MEDICARE: MARIPOSA WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DI 60129238	WA
2	133V00000X	Registered Dietitian	1003914
3	225700000X	Massage Therapist	MA 60012489	WA

General Provider Information

NPI Number	:	1548602220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIPOSA WELLNESS

Provider Business Mailing Address
First Line	:	109 NW 39TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-4924
Country	:	US
Telephone Number	:	707-832-8407
Fax Number	:

Provider Business Practice Location Address
First Line	:	4033 STONE WAY N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8011
Country	:	US
Telephone Number	:	707-832-8407
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SARA MARIE PRATO
Credential	:	LMP, RD, CD
Telephone Number	:	707-832-8407

Provider Enumeration Date	:	07/23/2013
Last Update Date	:	07/23/2013

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Directions to “MARIPOSA WELLNESS ” Practice Location

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