Provider Demographics
NPI:1962751974
Name:DOS SANOS, TINA
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:DOS SANOS
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 1:12514 141ST ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-3256
Mailing Address - Country:US
Mailing Address - Phone:206-387-5241
Mailing Address - Fax:
Practice Address - Street 1:6800 E GREEN LAKE WAY N STE 250
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5400
Practice Address - Country:US
Practice Address - Phone:206-387-5241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60280074225700000X
WA602548234374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula