Provider Demographics
NPI:1407220361
Name:SIMONE, IRENY
Entity Type:Individual
Prefix:
First Name:IRENY
Middle Name:
Last Name:SIMONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13610 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE #22
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4037
Mailing Address - Country:US
Mailing Address - Phone:480-588-6163
Mailing Address - Fax:
Practice Address - Street 1:13610 N SCOTTSDALE RD
Practice Address - Street 2:SUITE #22
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4037
Practice Address - Country:US
Practice Address - Phone:480-588-6163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ#MT-14287171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor