Provider Demographics
NPI:1396161923
Name:WASHINGTON, SIMONE
Entity type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 NORTH ARROWHEAD AVE.
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:N/A
Mailing Address - Zip Code:92377
Mailing Address - Country:UM
Mailing Address - Phone:909-562-4101
Mailing Address - Fax:
Practice Address - Street 1:2235 N ARROWHEAD AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-4564
Practice Address - Country:US
Practice Address - Phone:909-562-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366423954171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications