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General NPI Number Information
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NPI Number | 1366853517
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Entity Type | Organization
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Legal Business Name | SIMON ADVENTURES, LLC
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Dates
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Enumeration Date | 05/09/2014
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Last Update Date | 05/09/2014
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Provider Practice Location Address
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Address Line | 19401 SAINT JUDE DR
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City | SANTA ANA
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State | CA
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Zip | 92705-1342
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Country | US
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Telephone | 714-669-1470
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Fax | 714-669-8153
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Provider Business Mailing Address
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Address Line | 3881 ALTON PKWY SUITE A
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City | IRVINE
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State | CA
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Zip | 92606-8224
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Country | US
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Telephone | 949-383-5388
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Fax | 949-783-0891
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MITCHELL D SIMON
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Credential |
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Telephone | 714-920-5777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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