Provider Demographics
NPI:1770058836
Name:SIMOK, MATTHEW (ATC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:SIMOK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 E COVINA BLVD
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1651
Mailing Address - Country:US
Mailing Address - Phone:626-915-5841
Mailing Address - Fax:
Practice Address - Street 1:1430 E COVINA BLVD
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-1651
Practice Address - Country:US
Practice Address - Phone:626-915-5841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABOC3148382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer