Provider Demographics
NPI:1376064949
Name:VALMONTE, MARIANNE YANCHA
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:YANCHA
Last Name:VALMONTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S GRADY WAY STE LL25
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-3218
Mailing Address - Country:US
Mailing Address - Phone:425-228-5217
Mailing Address - Fax:
Practice Address - Street 1:15 S GRADY WAY STE LL25
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3218
Practice Address - Country:US
Practice Address - Phone:425-228-5217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60776794225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60776794OtherDEPT OF HEALTH