MEDICARE: DR. DEJARRA KAMIL SIMS N.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	175F00000X	Naturopath	ND-751	CA

General Provider Information

NPI Number	:	1902031800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEJARRA KAMIL SIMS N.M.D.

Provider Business Mailing Address
First Line	:	4231 BALBOA AVE # 1109
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5504
Country	:	US
Telephone Number	:	619-841-1226
Fax Number	:

Provider Business Practice Location Address
First Line	:	10505 SORRENTO VALLEY RD STE 225
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1601
Country	:	US
Telephone Number	:	619-345-3111
Fax Number	:

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

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	08/25/2023

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