Healthcare Provider Details

I. General information

NPI: 1417031998
Provider Name (Legal Business Name): BERNARD SIMON JORGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11227 VALLEY BLVD
EL MONTE CA
91731-3225
US

IV. Provider business mailing address

11227 VALLEY BLVD
EL MONTE CA
91731-3225
US

V. Phone/Fax

Practice location:
  • Phone: 626-442-7077
  • Fax: 626-442-2640
Mailing address:
  • Phone: 626-442-7077
  • Fax: 626-442-2640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA33386
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA-33386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: