Healthcare Provider Details

I. General information

NPI: 1336024314
Provider Name (Legal Business Name): MALAYSIA SIMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 E HOSPITALITY LN STE 400
SAN BERNARDINO CA
92408-3545
US

IV. Provider business mailing address

32326 CLINTON KEITH RD STE 201
WILDOMAR CA
92595-7317
US

V. Phone/Fax

Practice location:
  • Phone: 907-770-0862
  • Fax: 999-999-9999
Mailing address:
  • Phone: 858-264-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: