Healthcare Provider Details

I. General information

NPI: 1194711275
Provider Name (Legal Business Name): MARY F SIMON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY F WEISBERG MD

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 N WEST AVE STE 102
FRESNO CA
93711-2376
US

IV. Provider business mailing address

5715 N WEST AVE STE 102
FRESNO CA
93711-2376
US

V. Phone/Fax

Practice location:
  • Phone: 559-228-3069
  • Fax: 559-228-9228
Mailing address:
  • Phone: 559-228-3069
  • Fax: 559-228-9228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: