Healthcare Provider Details

I. General information

NPI: 1154856268
Provider Name (Legal Business Name): TANYA AMELIE SIMARD D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23252 ARROYO VIS
RANCHO SANTA MARGARITA CA
92688-2610
US

IV. Provider business mailing address

23252 ARROYO VIS
RANCHO SANTA MARGARITA CA
92688-2610
US

V. Phone/Fax

Practice location:
  • Phone: 949-264-6440
  • Fax:
Mailing address:
  • Phone: 949-264-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number33836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: