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General NPI Number Information
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NPI Number | 1790886687
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Entity Type | Organization
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Legal Business Name | NICHOLAS D. SIMOPOULOS MD INC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 1000 FOWLER WAY STE 5
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City | PLACERVILLE
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State | CA
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Zip | 95667-5738
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Country | US
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Telephone | 530-626-1277
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Fax | 530-626-3265
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Provider Business Mailing Address
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Address Line | 1000 FOWLER WAY STE 5
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City | PLACERVILLE
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State | CA
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Zip | 95667-5738
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Country | US
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Telephone | 530-626-1277
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Fax | 530-626-3265
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Authorized Official
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Title or Position | PRESIDENT
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Name | NICHOLAS DEMETRIOS SIMOPOULOS
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Credential | MD
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Telephone | 530-626-1277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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