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General NPI Number Information
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NPI Number | 1083356869
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Entity Type | Individual
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Provider Name | SIMONE DESHIELDS
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Gender | Female
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 1001 POTRERO AVE BLDG 80-83
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-3518
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Country | US
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Telephone | 628-206-5252
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Fax |
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Provider Business Mailing Address
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Address Line | 2245 JOHN MATICH DR
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City | COLTON
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State | CA
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Zip | 92324-9513
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Country | US
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Telephone | 909-498-6442
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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