Provider Demographics
NPI:1770091993
Name:SIMON, PAULA A (MT ASCP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:A
Last Name:SIMON
Suffix:
Gender:F
Credentials:MT ASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1788 LILY POND CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-2196
Mailing Address - Country:US
Mailing Address - Phone:702-334-6184
Mailing Address - Fax:
Practice Address - Street 1:1788 LILY POND CIR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-2196
Practice Address - Country:US
Practice Address - Phone:702-334-6184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ00720583156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist