Provider Demographics
NPI:1396885984
Name:NAVARRO, TRACINA MARIE (LMP)
Entity type:Individual
Prefix:MRS
First Name:TRACINA
Middle Name:MARIE
Last Name:NAVARRO
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 1:19513 SE 265TH ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5056
Mailing Address - Country:US
Mailing Address - Phone:206-300-5241
Mailing Address - Fax:253-631-7116
Practice Address - Street 1:19513 SE 265TH ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-5056
Practice Address - Country:US
Practice Address - Phone:206-300-5241
Practice Address - Fax:253-631-7116
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015877225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA155162OtherLABOR & INDUSTRIES
WA235183100001OtherPREMERA BLUE CROSS