Basic Information
| Provider Information | |||||||||
| NPI: | 1659898468 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STRUNIN | ||||||||
| FirstName: | SIMONE | ||||||||
| MiddleName: | ANNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2425 BISSO LN STE 200 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945204886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9255215767 | ||||||||
| FaxNumber: | 9256465662 | ||||||||
| Practice Location | |||||||||
| Address1: | 2523 EL PORTAL DR STE 103 | ||||||||
| Address2: | |||||||||
| City: | SAN PABLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 948063305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102153700 | ||||||||
| FaxNumber: | 5102153720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2017 | ||||||||
| LastUpdateDate: | 08/23/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | D8339561 | CA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | D8339561 | 01 | CA | DRIVERS LICENSE | OTHER |