MEDICARE: AWILDA GONZALEZ-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	253Z00000X	In Home Supportive Care Agency	182988	OH

General Provider Information

NPI Number	:	1659979821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AWILDA GONZALEZ-SIMMONS

Provider Business Mailing Address
First Line	:	1332 BROOKLINE RD # 202
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44121-2565
Country	:	US
Telephone Number	:	216-882-8118
Fax Number	:

Provider Business Practice Location Address
First Line	:	1332 BROOKLINE RD # 202
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44121-2565
Country	:	US
Telephone Number	:	216-882-8118
Fax Number	:

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

Provider Enumeration Date	:	10/11/2020
Last Update Date	:	10/11/2020

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Directions to “ AWILDA GONZALEZ-SIMMONS ” Practice Location

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