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General NPI Number Information
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NPI Number | 1407912173
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Entity Type | Individual
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Provider Name | JACKIE SIMS PILJAY CCS
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Gender | Female
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 815 BUENA VISTA AVE W
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City | SAN FRANCISCO
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State | CA
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Zip | 94117-4108
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Country | US
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Telephone | 415-934-6872
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Fax | 415-863-0622
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Provider Business Mailing Address
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Address Line | 1125 TOKAY CMN
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City | LIVERMORE
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State | CA
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Zip | 94550-4855
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Country | US
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Telephone | 925-337-3675
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 380019BN
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License Number State | CA
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