Healthcare Provider Details

I. General information

NPI: 1255289252
Provider Name (Legal Business Name): JESSICA SIMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2961 DYER WAY
PLACERVILLE CA
95667-9027
US

IV. Provider business mailing address

2961 DYER WAY
PLACERVILLE CA
95667-9027
US

V. Phone/Fax

Practice location:
  • Phone: 530-303-8729
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberB20260121306
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: