Provider Demographics
NPI:1295212496
Name:SIMPKINS, ROBERTA JUDITH (RDA)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:JUDITH
Last Name:SIMPKINS
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:JUDITH
Other - Last Name:SIMPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30035 HAUN RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-6805
Mailing Address - Country:US
Mailing Address - Phone:951-566-6060
Mailing Address - Fax:
Practice Address - Street 1:30035 HAUN RD BLDG B
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-6805
Practice Address - Country:US
Practice Address - Phone:951-566-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51035126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51035Medicaid