Provider Demographics
NPI:1073237061
Name:NEGRE MARRON WELLNESS
Entity Type:Organization
Organization Name:NEGRE MARRON WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTERO
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:707-688-9253
Mailing Address - Street 1:31919 1ST AVE S STE 105
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5258
Mailing Address - Country:US
Mailing Address - Phone:206-717-5644
Mailing Address - Fax:
Practice Address - Street 1:31919 1ST AVE S STE 105
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5258
Practice Address - Country:US
Practice Address - Phone:206-717-5644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center