Provider Demographics
NPI:1790372084
Name:SIMON, OLGA M
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:M
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 1:741 GLENVIA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-2427
Mailing Address - Country:US
Mailing Address - Phone:818-554-9690
Mailing Address - Fax:
Practice Address - Street 1:741 GLENVIA ST STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-2427
Practice Address - Country:US
Practice Address - Phone:818-554-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician