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NPI Code Detail

MEDICARE: TRAVIS SIMAK

MEDICARE: TRAVIS SIMAK
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
1101YP2500XProfessional Counselor21470CA
2390200000XStudent in an Organized Health Care Education/Training ProgramCA

General Provider Information

NPI Number : 1205664992
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRAVIS SIMAK
Provider Business Mailing Address
First Line : 2865 LOGAN AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92113-2411
Country : US
Telephone Number : 619-232-4357
Fax Number :
Provider Business Practice Location Address
First Line : 2865 LOGAN AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92113-2411
Country : US
Telephone Number : 619-232-4357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2024
Last Update Date : 03/18/2026

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1942375621 — MS. IRENE CAROL WEISS MA
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1912072356 — MS. JEMMA ANNETTE COLLINS MSHS
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1487729182 — MS. SEBRENA ANGELA HARRIS R.N.
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Directions to “ TRAVIS SIMAK ” Practice Location

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