Provider Demographics
NPI:1568581346
Name:SIMI OAKS INC.
Entity Type:Organization
Organization Name:SIMI OAKS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:FEDERER
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-581-4357
Mailing Address - Street 1:67 COZUMEL PL
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4039
Mailing Address - Country:US
Mailing Address - Phone:805-581-4357
Mailing Address - Fax:805-581-6917
Practice Address - Street 1:2345 ERRINGER RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2235
Practice Address - Country:US
Practice Address - Phone:805-581-4357
Practice Address - Fax:805-581-6917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB 30655103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty