=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700457769
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. ANTOINE CHRISTOPHER SIMS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2021
-----------------------------------------------------
Last Update Date | 08/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25190 HANCOCK AVE STE B
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92562-5984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-805-0759
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 152 YOSEMITE AVE
-----------------------------------------------------
City | PERRIS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92570-5566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-437-5774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------