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General NPI Number Information
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NPI Number | 1790263523
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Entity Type | Individual
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Provider Name | SIMONE I JOSHUA
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Gender | Female
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 5762 BOLSA AVE STE 100
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-1172
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Country | US
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Telephone | 657-234-4119
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Fax |
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Provider Business Mailing Address
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Address Line | 6 CABOT
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City | IRVINE
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State | CA
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Zip | 92620-2609
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Country | US
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Telephone | 310-488-0385
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-72531
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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