Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | A169116 | CA |
N | 207P00000X | Emergency Physician | MD047309 | DC |
NPI | 1013395011 |
---|---|
Provider Name | Andrew Simmons |
First Address | San Bernardino, CA 92423-3082 |
Second Address | Loma Linda, CA 92354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2015 |
Last Update Date | 08/09/2020 |