Healthcare Provider Details

I. General information

NPI: 1013297407
Provider Name (Legal Business Name): SIMON AFEEF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9153 WAGNER RIVER CIR
FOUNTAIN VALLEY CA
92708-6449
US

IV. Provider business mailing address

9153 WAGNER RIVER CIR
FOUNTAIN VALLEY CA
92708-6449
US

V. Phone/Fax

Practice location:
  • Phone: 281-462-1285
  • Fax: 281-462-1554
Mailing address:
  • Phone: 281-462-1285
  • Fax: 281-462-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberCNIM520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: