Provider Demographics
NPI:1679370217
Name:WHITE, TREJAUN CEMAL (MA60689769)
Entity type:Individual
Prefix:
First Name:TREJAUN
Middle Name:CEMAL
Last Name:WHITE
Suffix:
Gender:
Credentials:MA60689769
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 MARTIN LUTHER KING JR WAY APT 204
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-888-3777
Mailing Address - Fax:
Practice Address - Street 1:3410 CLAREMONT AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-6815
Practice Address - Country:US
Practice Address - Phone:206-725-0747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60689769225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist