Healthcare Provider Details

I. General information

NPI: 1134571748
Provider Name (Legal Business Name): ADRIA SIMON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 06/25/2022
Certification Date: 06/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20103 LAKE CHABOT RD
CASTRO VALLEY CA
94546-5305
US

IV. Provider business mailing address

PO BOX 98
SAN DIMAS CA
91773-0098
US

V. Phone/Fax

Practice location:
  • Phone: 510-727-3015
  • Fax: 626-623-1227
Mailing address:
  • Phone: 877-346-2211
  • Fax: 626-623-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD466534
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMT211577
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA178515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: