MEDICARE: KRISTINA MARIE SIMMONS

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1255531208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA MARIE SIMMONS

Provider Business Mailing Address
First Line	:	1250 HARBOR BLVD
Second Line	:	SUITE 600
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3453
Country	:	US
Telephone Number	:	916-376-8591
Fax Number	:	916-376-8595

Provider Business Practice Location Address
First Line	:	1250 HARBOR BLVD
Second Line	:	SUITE 600
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3453
Country	:	US
Telephone Number	:	916-376-8591
Fax Number	:	916-376-8595

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

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	08/13/2007

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