MEDICARE: SIMONE EASTERBROOK DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	21144	CA

General Provider Information

NPI Number	:	1194306878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMONE EASTERBROOK DO

Provider Business Mailing Address
First Line	:	2240 MERCURY WAY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95407-5413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 MERCURY WAY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95407-5413
Country	:	US
Telephone Number	:	707-657-3142
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2021
Last Update Date	:	11/15/2024

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Directions to “ SIMONE EASTERBROOK DO” Practice Location

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