Provider Demographics
NPI:1528213618
Name:SIMONIN, VIRGINIA ADELAIDE (LMT)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ADELAIDE
Last Name:SIMONIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4265 SE 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-2109
Mailing Address - Country:US
Mailing Address - Phone:503-760-2509
Mailing Address - Fax:
Practice Address - Street 1:4265 SE 116TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-2109
Practice Address - Country:US
Practice Address - Phone:503-760-2509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2186247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other