Healthcare Provider Details

I. General information

NPI: 1376477711
Provider Name (Legal Business Name): SIMON MASIH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 21ST ST SE STE B
RIO RANCHO NM
87124-4030
US

IV. Provider business mailing address

3003 ZIA ST NE
RIO RANCHO NM
87144-5345
US

V. Phone/Fax

Practice location:
  • Phone: 505-804-3808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: