Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 33836 | CA |
Y | 213ER0200X | Radiology | 33836 | CA |
NPI | 1154856268 |
---|---|
Provider Name | Tanya Amelie Simard |
First Address | Rancho Santa Margarita, CA 92688-2610 |
Second Address | Rancho Santa Margarita, CA 92688-2610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2017 |
Last Update Date | 26/04/2017 |