Provider Demographics
NPI:1831926161
Name:SIMONE, ALYSON
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:SIMONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1687 MONARCH
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-7709
Mailing Address - Country:US
Mailing Address - Phone:847-224-0491
Mailing Address - Fax:
Practice Address - Street 1:600 W SANTA ANA BLVD STE 600
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4552
Practice Address - Country:US
Practice Address - Phone:714-953-4455
Practice Address - Fax:714-542-2793
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty