Provider Demographics
NPI:1649811142
Name:PACO, MARIA-SOFIA MASCARINAS (LMP)
Entity type:Individual
Prefix:
First Name:MARIA-SOFIA
Middle Name:MASCARINAS
Last Name:PACO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 LEARY AVE NW STE 202
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4070
Mailing Address - Country:US
Mailing Address - Phone:206-297-6013
Mailing Address - Fax:206-582-3472
Practice Address - Street 1:5401 LEARY AVE NW STE 202
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4070
Practice Address - Country:US
Practice Address - Phone:206-297-6013
Practice Address - Fax:206-582-3472
Is Sole Proprietor?:No
Enumeration Date:2019-10-05
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60911835225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist