Healthcare Provider Details

I. General information

NPI: 1639251572
Provider Name (Legal Business Name): SIMON V JOSEPH RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 HOLCOMBE BLVD
HOUSTON TX
77030-4211
US

IV. Provider business mailing address

14023 CORAL BEAN DR
SUGAR LAND TX
77478-2128
US

V. Phone/Fax

Practice location:
  • Phone: 713-794-7961
  • Fax:
Mailing address:
  • Phone: 281-240-9885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number51789
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: