Provider Demographics
NPI:1548658073
Name:TANTOCO, ROLANDO
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:
Last Name:TANTOCO
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 1:147 NW 183RD ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-3439
Mailing Address - Country:US
Mailing Address - Phone:206-801-7174
Mailing Address - Fax:206-801-7470
Practice Address - Street 1:147 NW 183RD ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-3439
Practice Address - Country:US
Practice Address - Phone:206-801-7174
Practice Address - Fax:206-801-7470
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4594013747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider