Healthcare Provider Details

I. General information

NPI: 1548308331
Provider Name (Legal Business Name): SARAH LOUISE SIMMONS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR 0603R
LA JOLLA CA
92093-5004
US

IV. Provider business mailing address

4952 MOUNT FRISSELL DR
SAN DIEGO CA
92117-4808
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-4040
  • Fax:
Mailing address:
  • Phone: 858-715-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA91340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: