Provider Demographics
NPI:1801209457
Name:SIMON, PHONEXAY LALA (LAC, EAMP)
Entity Type:Individual
Prefix:
First Name:PHONEXAY
Middle Name:LALA
Last Name:SIMON
Suffix:
Gender:F
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4038 STONE WAY N APT 301
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2901 NE BLAKELEY ST
Practice Address - Street 2:STE 3B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3164
Practice Address - Country:US
Practice Address - Phone:509-554-0516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60446929171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist