Basic Information
| Provider Information | |||||||||
| NPI: | 1245896828 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMONI | ||||||||
| FirstName: | LIANA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 DISTEL CIR | ||||||||
| Address2: | |||||||||
| City: | LOS ALTOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940221408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9257767725 | ||||||||
| FaxNumber: | 5105067728 | ||||||||
| Practice Location | |||||||||
| Address1: | 4053 LONE TREE WAY STE 201 | ||||||||
| Address2: | |||||||||
| City: | ANTIOCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945316210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9257767725 | ||||||||
| FaxNumber: | 5105067727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2019 | ||||||||
| LastUpdateDate: | 06/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 95011758 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | NP95011758 | 01 | CA | STATE MEDICAL LICENSE | OTHER |