1801209457 NPI number — PHONEXAY LALA SIMON L.AC, EAMP

Table of content: PHONEXAY LALA SIMON L.AC, EAMP (NPI 1801209457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801209457 NPI number — PHONEXAY LALA SIMON L.AC, EAMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMON
Provider First Name:
PHONEXAY
Provider Middle Name:
LALA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.AC, EAMP
Provider Gender Code:
F

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:
1801209457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4038 STONE WAY N APT 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98103-8026
Provider Business Mailing Address Country Code:
US
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:
2901 NE BLAKELEY ST
Provider Second Line Business Practice Location Address:
STE 3B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-3164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-554-0516
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2014

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC 60446929 , 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)





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