=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265589170
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAIZA SIMON M.S. ED., C.C.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8510 SW 8TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-4053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-266-5353
-----------------------------------------------------
Fax | 305-266-6550
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16400 SW 95TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33196-1060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-299-9391
-----------------------------------------------------
Fax | 305-266-6550
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SA 8767
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------