Provider Demographics
NPI:1568878536
Name:SIMON, ISIS
Entity Type:Individual
Prefix:
First Name:ISIS
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8304 COMMERCE WAY
Mailing Address - Street 2:APT 236
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1605
Mailing Address - Country:US
Mailing Address - Phone:305-914-5210
Mailing Address - Fax:
Practice Address - Street 1:8304 COMMERCE WAY
Practice Address - Street 2:APT 236
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1605
Practice Address - Country:US
Practice Address - Phone:305-914-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program