Provider Demographics
NPI:1477719037
Name:JERALD I SIMON, M.D., INC
Entity Type:Organization
Organization Name:JERALD I SIMON, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICIONER
Authorized Official - Prefix:
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-375-8501
Mailing Address - Street 1:4272 STALWART DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6025
Mailing Address - Country:US
Mailing Address - Phone:310-541-3164
Mailing Address - Fax:
Practice Address - Street 1:24050 MADISON ST
Practice Address - Street 2:SUITE 217
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6015
Practice Address - Country:US
Practice Address - Phone:310-375-8501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC253582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA32854Medicare UPIN
CAC25358Medicare PIN