Provider Demographics
NPI:1477537041
Name:SIMMONS, EMMA M (MD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:M
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92521-9800
Mailing Address - Country:US
Mailing Address - Phone:951-486-5573
Mailing Address - Fax:951-486-5482
Practice Address - Street 1:26520 CACTUS AVE.
Practice Address - Street 2:DEPARTMENT OF FAMILY MEDICINE
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-3927
Practice Address - Country:US
Practice Address - Phone:951-486-4000
Practice Address - Fax:951-486-5595
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG88995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7005583Medicaid
RI007061099OtherMEDICARE PTAN
RI007061099OtherMEDICARE PTAN