Provider Demographics
NPI:1265589170
Name:SIMON, RAIZA (MS ED, CCC)
Entity type:Individual
Prefix:MRS
First Name:RAIZA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:MS ED, CCC
Other - Prefix:MS
Other - First Name:RAIZA
Other - Middle Name:
Other - Last Name:ANGULO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ED
Mailing Address - Street 1:16400 SW 95TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1060
Mailing Address - Country:US
Mailing Address - Phone:305-299-9391
Mailing Address - Fax:305-266-6550
Practice Address - Street 1:8510 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4053
Practice Address - Country:US
Practice Address - Phone:305-266-5353
Practice Address - Fax:305-266-6550
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8767235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist