Healthcare Provider Details

I. General information

NPI: 1104732643
Provider Name (Legal Business Name): CAROLINA CAIN SIMMS R.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 FRONT ST FL 6
SAN FRANCISCO CA
94111-4422
US

IV. Provider business mailing address

1194 COTTER WAY
HAYWARD CA
94541-2103
US

V. Phone/Fax

Practice location:
  • Phone: 415-956-2884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number594787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: