Healthcare Provider Details

I. General information

NPI: 1063325371
Provider Name (Legal Business Name): DAVID SIMONSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 VIA PEDRO
VISTA CA
92084-4732
US

IV. Provider business mailing address

1517 VIA PEDRO
VISTA CA
92084-4732
US

V. Phone/Fax

Practice location:
  • Phone: 702-373-3390
  • Fax:
Mailing address:
  • Phone: 702-373-3390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number15710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: