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General NPI Number Information
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NPI Number | 1396161923
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Entity Type | Individual
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Provider Name | MRS. SIMONE WASHINGTON
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Gender | Female
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Dates
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Enumeration Date | 03/06/2014
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Last Update Date | 03/06/2014
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Provider Practice Location Address
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Address Line | 2235 N ARROWHEAD AVE
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City | RIALTO
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State | CA
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Zip | 92377-4564
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Country | US
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Telephone | 909-562-4101
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Fax |
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Provider Business Mailing Address
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Address Line | 2235 NORTH ARROWHEAD AVE.
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City | RIALTO
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State | N/A
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Zip | 92377
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Country | UM
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Telephone | 909-562-4101
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | 366423954
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License Number State | CA
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