Provider Demographics
NPI:1194104679
Name:WASHINGTON, VICKIE YVONNE (LAC)
Entity type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:YVONNE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1561 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-2626
Mailing Address - Country:US
Mailing Address - Phone:415-269-6320
Mailing Address - Fax:
Practice Address - Street 1:632 COMMERCIAL ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-2573
Practice Address - Country:US
Practice Address - Phone:415-795-8100
Practice Address - Fax:415-795-4404
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16602171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist