Provider Demographics
NPI:1487670352
Name:SIMKIN, JOSEFA FAY (MD)
Entity Type:Individual
Prefix:
First Name:JOSEFA
Middle Name:FAY
Last Name:SIMKIN
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 1:266 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-3139
Mailing Address - Country:US
Mailing Address - Phone:831-761-1141
Mailing Address - Fax:831-722-7826
Practice Address - Street 1:266 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3139
Practice Address - Country:US
Practice Address - Phone:831-761-1141
Practice Address - Fax:831-722-7826
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A438360Medicaid
CA00A438360Medicaid
CA00A438360Medicare ID - Type Unspecified