Healthcare Provider Details

I. General information

NPI: 1801278148
Provider Name (Legal Business Name): STEPHEN SIMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 N FAIR OAKS AVE 3RD FLOOR
PASADENA CA
91103-3069
US

IV. Provider business mailing address

751 N FAIR OAKS AVE 3RD FLOOR
PASADENA CA
91103-3069
US

V. Phone/Fax

Practice location:
  • Phone: 213-718-0256
  • Fax: 818-301-7443
Mailing address:
  • Phone: 213-718-0256
  • Fax: 818-301-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY17653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: