Provider Demographics
NPI:1750538161
Name:SIMONS, SEAN PATRICK (RT (R)(CT) ARRT CRT)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:PATRICK
Last Name:SIMONS
Suffix:
Gender:M
Credentials:RT (R)(CT) ARRT CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 VALLEY RD SPC 47
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7839
Mailing Address - Country:US
Mailing Address - Phone:619-791-5105
Mailing Address - Fax:
Practice Address - Street 1:3131 VALLEY RD SPC 47
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7839
Practice Address - Country:US
Practice Address - Phone:619-791-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2176862471C3401X
CARHF 671202471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography