Healthcare Provider Details

I. General information

NPI: 1952844185
Provider Name (Legal Business Name): STACY SIMONS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2016
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 N TORREY PINES RD
LA JOLLA CA
92037-1035
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-824-5400
  • Fax:
Mailing address:
  • Phone: 858-554-9924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number480432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: