Basic Information
| Provider Information | |||||||||
| NPI: | 1689099517 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RALLS | ||||||||
| FirstName: | SIMONE | ||||||||
| MiddleName: | NATALYA | ||||||||
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| Credential: | BSN,RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 SUNRISE AVE STE 701 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956613483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167835207 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 333 SUNRISE AVE STE 701 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956613483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167835207 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2014 | ||||||||
| LastUpdateDate: | 05/02/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 163W00000X | 95084823 | CA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.