Provider Demographics
NPI:1477508562
Name:SIMON, MICHELLE LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LOUISE
Last Name:SIMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:195 AVIATION WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2059
Mailing Address - Country:US
Mailing Address - Phone:831-728-8250
Mailing Address - Fax:831-707-2777
Practice Address - Street 1:252 GREEN VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3138
Practice Address - Country:US
Practice Address - Phone:831-728-0222
Practice Address - Fax:831-707-2777
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2015-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG42252208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G422520Medicaid
CA00G422520Medicaid