Provider Demographics
NPI:1487397444
Name:CARMONA, MARLENY (MD)
Entity type:Individual
Prefix:
First Name:MARLENY
Middle Name:
Last Name:CARMONA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-942-3125
Mailing Address - Fax:509-585-8173
Practice Address - Street 1:3900 S ZINTEL WAY STE 110
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-5044
Practice Address - Country:US
Practice Address - Phone:509-942-3125
Practice Address - Fax:509-585-3125
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD61638613207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program