Provider Demographics
NPI:1275024556
Name:SIMON, CARLOS ANTONIO (MD, PHD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ANTONIO
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CAMINO DE LA PLAYA (URBANIZACION MAR PLATA)
Mailing Address - Street 2:
Mailing Address - City:EL PUIG DE SANTAMARIA
Mailing Address - State:VALENCIA
Mailing Address - Zip Code:46540
Mailing Address - Country:ES
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11B, NARCIS MONTURIOL ESTARRIOL
Practice Address - Street 2:PARCELA B
Practice Address - City:PATERNA
Practice Address - State:VALENCIA
Practice Address - Zip Code:46980
Practice Address - Country:ES
Practice Address - Phone:305-501-4948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ464612993207VE0102X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty