Provider Demographics
NPI:1821612888
Name:SIMO, HILDA I I
Entity Type:Individual
Prefix:
First Name:HILDA
Middle Name:I
Last Name:SIMO
Suffix:I
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 1:12140 SW 248TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6045
Mailing Address - Country:US
Mailing Address - Phone:305-609-3090
Mailing Address - Fax:
Practice Address - Street 1:12140 SW 248TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6045
Practice Address - Country:US
Practice Address - Phone:305-609-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician