Provider Demographics
NPI:1851800056
Name:SIMON, DELISA (RN, BSN, MSN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:DELISA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:RN, BSN, MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4439 STONERIDGE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8339
Mailing Address - Country:US
Mailing Address - Phone:925-461-2840
Mailing Address - Fax:800-940-9545
Practice Address - Street 1:4439 STONERIDGE DR STE 110
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588
Practice Address - Country:US
Practice Address - Phone:925-461-2840
Practice Address - Fax:800-940-9545
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily