1588735476 NPI number — ERIN JESSICA SIMMS MD

Table of content: ERIN JESSICA SIMMS MD (NPI 1588735476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588735476 NPI number — ERIN JESSICA SIMMS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMMS
Provider First Name:
ERIN
Provider Middle Name:
JESSICA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIMMS-EDWARDS
Provider Other First Name:
ERIN
Provider Other Middle Name:
JESSICA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1588735476
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
744 52ND ST
Provider Second Line Business Mailing Address:
SUITE 4200
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94609-1810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-428-3456
Provider Business Mailing Address Fax Number:
510-450-5613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
744 52ND ST
Provider Second Line Business Practice Location Address:
SUITE 4200
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-428-3456
Provider Business Practice Location Address Fax Number:
510-450-5613
Provider Enumeration Date:
11/13/2006

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: 207YX0007X , with the licence number:  G79837 , 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)

  • Identifier: 00G798370 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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