Healthcare Provider Details

I. General information

NPI: 1396098976
Provider Name (Legal Business Name): SIMPLY GREATH HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2012
Last Update Date: 10/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 DARDANELLI LN STE 1C
LOS GATOS CA
95032-1421
US

IV. Provider business mailing address

360 DARDANELLI LN STE 1C
LOS GATOS CA
95032-1421
US

V. Phone/Fax

Practice location:
  • Phone: 408-656-0815
  • Fax:
Mailing address:
  • Phone: 408-656-0815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberG79389
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberG79389
License Number StateCA

VIII. Authorized Official

Name: DR. SUMA SINGH
Title or Position: PHYSICIAN
Credential: MD
Phone: 408-656-0815