Provider Demographics
NPI:1659671162
Name:VICTORIA ROBERT'S SALON & SPA
Entity type:Organization
Organization Name:VICTORIA ROBERT'S SALON & SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-951-4599
Mailing Address - Street 1:PO BOX 6157
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98064-6157
Mailing Address - Country:US
Mailing Address - Phone:253-951-4599
Mailing Address - Fax:253-630-3103
Practice Address - Street 1:438 RAMSAY WAY
Practice Address - Street 2:SUITE 106
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4532
Practice Address - Country:US
Practice Address - Phone:253-856-0814
Practice Address - Fax:253-630-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-31
Last Update Date:2010-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60014299305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service