MEDICARE: DR. PAUL MENOLETTE SIMON M.D.

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	207R00000X	Internal Medicine Physician	35.088338	OH
2	207R00000X	Internal Medicine Physician	C54978	CA

General Provider Information

NPI Number	:	1598970626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL MENOLETTE SIMON M.D.

Provider Business Mailing Address
First Line	:	8810 RIO SAN DIEGO DRIVE
Second Line	:	MISSION VALLEY VA CLINIC
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-2720
Country	:	US
Telephone Number	:	619-400-5000
Fax Number	:	619-400-5050

Provider Business Practice Location Address
First Line	:	8810 RIO SAN DIEGO DRIVE
Second Line	:	MISSION VALLEY VA CLINIC
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-2720
Country	:	US
Telephone Number	:	619-400-5000
Fax Number	:	619-400-5050

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	05/23/2013

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