Provider Demographics
NPI:1265738173
Name:ANGELES SIMON, MARICARMEN (MA; CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARICARMEN
Middle Name:
Last Name:ANGELES SIMON
Suffix:
Gender:F
Credentials:MA; CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 HONOLULU AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1635
Mailing Address - Country:US
Mailing Address - Phone:917-907-4833
Mailing Address - Fax:
Practice Address - Street 1:2233 HONOLULU AVE STE 202
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1635
Practice Address - Country:US
Practice Address - Phone:917-907-4833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7422355S0801X
CA18847235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant