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NPI Code Detail

MEDICARE: STEPHEN M SIMON MD

MEDICARE: STEPHEN M SIMON MD
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
12085R0202XDiagnostic Radiology PhysicianG50753CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100G507530OTHERCABLUE SHIELD OF CA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285618389
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN M SIMON MD
Provider Business Mailing Address
First Line : DEPT LA 21789
Second Line :
City : PASADENA
State : CA
Zip : 91185-1789
Country : US
Telephone Number : 949-263-8620
Fax Number : 949-263-1639
Provider Business Practice Location Address
First Line : 27700 MEDICAL CENTER RD
Second Line :
City : MISSION VIEJO
State : CA
Zip : 92691-6426
Country : US
Telephone Number : 949-364-7744
Fax Number : 949-364-4233
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2005
Last Update Date : 11/30/2007

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