Provider Demographics
NPI:1043970486
Name:SOPERANEZ, RENE II (LMT)
Entity Type:Individual
Prefix:MR
First Name:RENE
Middle Name:
Last Name:SOPERANEZ
Suffix:II
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 HAY CANYON RD SPC 12
Mailing Address - Street 2:
Mailing Address - City:CASHMERE
Mailing Address - State:WA
Mailing Address - Zip Code:98815-9573
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2107
Practice Address - Country:US
Practice Address - Phone:509-663-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61256789225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist