Basic Information
| Provider Information | |||||||||
| NPI: | 1134571748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMON | ||||||||
| FirstName: | ADRIA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98 | ||||||||
| Address2: | |||||||||
| City: | SAN DIMAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917730098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8773462211 | ||||||||
| FaxNumber: | 6266231227 | ||||||||
| Practice Location | |||||||||
| Address1: | 20103 LAKE CHABOT RD | ||||||||
| Address2: | |||||||||
| City: | CASTRO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945465305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107273015 | ||||||||
| FaxNumber: | 6266231227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2016 | ||||||||
| LastUpdateDate: | 06/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD466534 | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MT211577 | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | A178515 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.