Healthcare Provider Details

I. General information

NPI: 1487283925
Provider Name (Legal Business Name): SIMON BACKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14445 OLIVE VIEW DR
SYLMAR CA
91342-1437
US

IV. Provider business mailing address

14445 OLIVE VIEW DR
SYLMAR CA
91342-1437
US

V. Phone/Fax

Practice location:
  • Phone: 747-210-4534
  • Fax:
Mailing address:
  • Phone: 917-374-4859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA190751
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberA190751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: