Healthcare Provider Details

I. General information

NPI: 1053058545
Provider Name (Legal Business Name): ELIZABETH ANN SIMS RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2941 4TH AVE STE B
SAN DIEGO CA
92103-5901
US

IV. Provider business mailing address

2941 4TH AVE STE B
SAN DIEGO CA
92103-5901
US

V. Phone/Fax

Practice location:
  • Phone: 888-789-9636
  • Fax: 888-909-6855
Mailing address:
  • Phone: 888-789-9636
  • Fax: 888-909-6855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number430393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: