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NPI Code Detail

MEDICARE: MS. CHANDA GAIL SIMMONS BACHELOR DEGREE

MEDICARE: MS. CHANDA GAIL SIMMONS BACHELOR DEGREE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1528133493
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHANDA GAIL SIMMONS BACHELOR DEGREE
Provider Business Mailing Address
First Line : 734 10TH AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-6502
Country : US
Telephone Number : 619-239-4663
Fax Number : 619-239-3045
Provider Business Practice Location Address
First Line : 734 10TH AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-6502
Country : US
Telephone Number : 619-239-4663
Fax Number : 619-239-3045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2006
Last Update Date : 07/08/2007

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