Provider Demographics
NPI:1770741332
Name:JAMESON, SIMON NMN
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:NMN
Last Name:JAMESON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 FOOTHILL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-2901
Mailing Address - Country:US
Mailing Address - Phone:805-682-5156
Mailing Address - Fax:805-563-0509
Practice Address - Street 1:2701 FOOTHILL RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-2901
Practice Address - Country:US
Practice Address - Phone:805-682-5156
Practice Address - Fax:805-563-0509
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24185302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization