Provider Demographics
NPI:1659592905
Name:RICHMOND, VICTORIA LEE (LMP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LEE
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 413
Mailing Address - Street 2:
Mailing Address - City:CARLSBORG
Mailing Address - State:WA
Mailing Address - Zip Code:98324
Mailing Address - Country:US
Mailing Address - Phone:360-460-0954
Mailing Address - Fax:
Practice Address - Street 1:863 CARLSBORG RD.
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98324
Practice Address - Country:US
Practice Address - Phone:360-460-0954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015465225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARYDER # 3332RIOtherREGENCE BLUESHIELD
WA3332RIOtherREGENCEBLUESHIELD
WAMA00015465OtherSTATE LICENSE
WA0206222OtherLABOR AND INDUSTRY