Provider Demographics
NPI:1346843158
Name:SIMUNOVIC, SILVIO (RDA)
Entity Type:Individual
Prefix:
First Name:SILVIO
Middle Name:
Last Name:SIMUNOVIC
Suffix:
Gender:M
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 20TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3448
Mailing Address - Country:US
Mailing Address - Phone:415-825-2329
Mailing Address - Fax:
Practice Address - Street 1:1471 20TH AVE APT 4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-3448
Practice Address - Country:US
Practice Address - Phone:415-825-2329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAK7L7R5Z9246RP1900X
CA90325126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy