1093749681 NPI number — JOHN SIMS P.T.

Table of content: JOHN SIMS P.T. (NPI 1093749681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093749681 NPI number — JOHN SIMS P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMS
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093749681
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25200 LA PAZ RD
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
LAGUNA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92653-5134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-770-8767
Provider Business Mailing Address Fax Number:
949-770-8767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23961 CALLE DE LA MAGDALENA
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
LAGUNA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92653-3616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-587-1155
Provider Business Practice Location Address Fax Number:
949-465-8159
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT32642 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com