Healthcare Provider Details

I. General information

NPI: 1184925141
Provider Name (Legal Business Name): SIMONMED IMAGING A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CHANNING AVE
PALO ALTO CA
94301-2801
US

IV. Provider business mailing address

PO BOX 51227
LOS ANGELES CA
90051-5527
US

V. Phone/Fax

Practice location:
  • Phone: 650-323-1343
  • Fax: 650-323-1352
Mailing address:
  • Phone: 888-685-3909
  • Fax: 800-508-4751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HOWARD J SIMON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 480-809-4829