Provider Demographics
NPI:1336612753
Name:MARIN, RICHARD REX (CPO)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:REX
Last Name:MARIN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4139
Mailing Address - Country:US
Mailing Address - Phone:253-383-4447
Mailing Address - Fax:253-383-7574
Practice Address - Street 1:723 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4139
Practice Address - Country:US
Practice Address - Phone:253-383-4447
Practice Address - Fax:253-383-7574
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOI60560917222Z00000X
WAPS60560910224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist