Healthcare Provider Details

I. General information

NPI: 1780506931
Provider Name (Legal Business Name): ANGEL M SIMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24356 SWARTZ DR STE 23
LAKE FOREST CA
92630-4744
US

IV. Provider business mailing address

1277 W LINDEN ST APT B
RIVERSIDE CA
92507-0802
US

V. Phone/Fax

Practice location:
  • Phone: 949-235-8374
  • Fax:
Mailing address:
  • Phone: 951-410-6703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number96302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: