Provider Demographics
NPI:1124188115
Name:SIMONS, PAMELA DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:DENISE
Last Name:SIMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:D
Other - Last Name:SIMONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:27225 CALAROGA AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4338
Mailing Address - Country:US
Mailing Address - Phone:510-342-0020
Mailing Address - Fax:510-342-0023
Practice Address - Street 1:27225 CALAROGA AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4338
Practice Address - Country:US
Practice Address - Phone:510-342-0020
Practice Address - Fax:510-342-0023
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR35005207V00000X
NHLT-2725207V00000X
CAG84922207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30207961Medicaid
CA00G711820Medicaid
CAF32924Medicare ID - Type Unspecified
CA00G711820Medicaid