Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | D.C.19606 | CA |
NPI | 1497077994 |
---|---|
Provider Name | Dr. Gregory Scott Simonian |
First Address | Costa Mesa, CA 92627-3130 |
Second Address | Costa Mesa, CA 92626-6130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2010 |
Last Update Date | 24/02/2010 |