Provider Demographics
NPI:1881236677
Name:RAYMOND, SIMSON (PA)
Entity type:Individual
Prefix:
First Name:SIMSON
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4415
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33424-4415
Mailing Address - Country:US
Mailing Address - Phone:786-630-3278
Mailing Address - Fax:
Practice Address - Street 1:URB TURABO GARDENS CALLE 5 #F1
Practice Address - Street 2:APT B
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00926-5527
Practice Address - Country:US
Practice Address - Phone:786-630-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-13
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16713-I390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program