Provider Demographics
NPI:1568954402
Name:SIMPSON, JOHN LESLIE
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LESLIE
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N ALESSANDRO ST
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-5545
Mailing Address - Country:US
Mailing Address - Phone:951-922-7209
Mailing Address - Fax:951-922-7210
Practice Address - Street 1:135 N ALESSANDRO ST
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-5545
Practice Address - Country:US
Practice Address - Phone:951-922-7209
Practice Address - Fax:951-922-7210
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator