Provider Demographics
NPI:1629615133
Name:SIMON HEALTH MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:SIMON HEALTH MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLYBABY
Authorized Official - Middle Name:DE LA CARIDAD
Authorized Official - Last Name:MONTEJO
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:305-898-5846
Mailing Address - Street 1:5600 SW 135TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5101
Mailing Address - Country:US
Mailing Address - Phone:305-898-5846
Mailing Address - Fax:
Practice Address - Street 1:10250 SW 56TH ST STE D201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7098
Practice Address - Country:US
Practice Address - Phone:305-877-6650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty