Healthcare Provider Details

I. General information

NPI: 1508535485
Provider Name (Legal Business Name): NATASHA SIMON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 PLACER ST
REDDING CA
96001-1170
US

IV. Provider business mailing address

1035 PLACER ST
REDDING CA
96001-1170
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-5710
  • Fax: 530-245-0833
Mailing address:
  • Phone: 530-246-5710
  • Fax: 530-245-0833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9114268
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number027012
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: