Provider Demographics
NPI:1184467722
Name:MARIANO, MARK ASIEL LOZANO
Entity type:Individual
Prefix:
First Name:MARK ASIEL
Middle Name:LOZANO
Last Name:MARIANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29122 120TH WAY SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-3268
Mailing Address - Country:US
Mailing Address - Phone:206-697-7467
Mailing Address - Fax:
Practice Address - Street 1:1347 AUBURN WAY N
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4110
Practice Address - Country:US
Practice Address - Phone:253-553-2415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP161120209225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant