=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104448752
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SIMA TEI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2020
-----------------------------------------------------
Last Update Date | 05/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 UPPER VIA CASITAS APT 14
-----------------------------------------------------
City | GREENBRAE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94904-2262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-699-6692
-----------------------------------------------------
Fax | 415-461-1359
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 175 UPPER VIA CASITAS APT 14
-----------------------------------------------------
City | GREENBRAE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94904-2262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-699-6692
-----------------------------------------------------
Fax | 415-461-1359
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number | 577610
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------