Provider Demographics
NPI:1154867315
Name:SIMOES, MILISSA (AT,C)
Entity Type:Individual
Prefix:
First Name:MILISSA
Middle Name:
Last Name:SIMOES
Suffix:
Gender:F
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19191 ROCKY SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-6591
Mailing Address - Country:US
Mailing Address - Phone:714-742-5479
Mailing Address - Fax:
Practice Address - Street 1:19191 ROCKY SUMMIT DR
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-6591
Practice Address - Country:US
Practice Address - Phone:714-742-5479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator