1225841000 NPI number — MR. JUSTIN ALLAN DALMACIO DPT

Table of content: MR. JUSTIN ALLAN DALMACIO DPT (NPI 1225841000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225841000 NPI number — MR. JUSTIN ALLAN DALMACIO DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DALMACIO
Provider First Name:
JUSTIN
Provider Middle Name:
ALLAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225841000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9989 BARNSTON DR E
Provider Second Line Business Mailing Address:
#75
Provider Business Mailing Address City Name:
SURREY
Provider Business Mailing Address State Name:
BRITISH COLUMBIA
Provider Business Mailing Address Postal Code:
V4N6N3
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8125 BIRCH BAY SQUARE ST STE 248
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAINE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98230-9847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-366-5511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
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Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT61620758 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)