Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | G31303 | CA |
NPI | 1255304622 |
---|---|
Provider Name | Dr. Ronald A. Simon |
First Address | San Diego, CA 92127-5705 |
Second Address | San Diego, CA 92130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 05/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G313030 | (05) | CA |
A44715 | (02) | CA |