Basic Information
| Provider Information | |||||||||
| NPI: | 1932417417 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMS | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9655 MONTE VISTA AVE STE 402 | ||||||||
| Address2: | |||||||||
| City: | MONTCLAIR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917632238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096261205 | ||||||||
| FaxNumber: | 9096700473 | ||||||||
| Practice Location | |||||||||
| Address1: | 9655 MONTE VISTA AVE STE 402 | ||||||||
| Address2: | |||||||||
| City: | MONTCLAIR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917632238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096261205 | ||||||||
| FaxNumber: | 9096700473 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2010 | ||||||||
| LastUpdateDate: | 10/13/2017 | ||||||||
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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 | 208M00000X | 20A11223 | CA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 20A11223 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.