Healthcare Provider Details

I. General information

NPI: 1689778946
Provider Name (Legal Business Name): SIMONA MARIANA SCUMPIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SIMONE SCUMPIA M.D.

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DR BLDG 3-300
AUSTIN TX
78758-5387
US

IV. Provider business mailing address

2200 PARK BEND DR BLDG 3-300
AUSTIN TX
78758-5387
US

V. Phone/Fax

Practice location:
  • Phone: 512-873-7377
  • Fax: 512-873-7576
Mailing address:
  • Phone: 512-873-7377
  • Fax: 512-873-7576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberH3521
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: