Provider Demographics
NPI:1205305679
Name:SIMON, MARGARET ELLEN I
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELLEN
Last Name:SIMON
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 1:4823 JACKSON ST UNIT D
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-2056
Mailing Address - Country:US
Mailing Address - Phone:951-258-2800
Mailing Address - Fax:
Practice Address - Street 1:2222 MARTIN STE 170
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1450
Practice Address - Country:US
Practice Address - Phone:949-474-5577
Practice Address - Fax:949-474-5575
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician