Provider Demographics
NPI:1760279111
Name:RANGEL, ALEX MARIO
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:MARIO
Last Name:RANGEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARIO
Other - Middle Name:ALEJANDRO
Other - Last Name:RANGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6315 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3571
Mailing Address - Country:US
Mailing Address - Phone:509-654-3881
Mailing Address - Fax:
Practice Address - Street 1:4309 W NOB HILL BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3971
Practice Address - Country:US
Practice Address - Phone:509-823-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN61459006122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist