Organization
FRED J SIMON, JR., M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRED J. SIMON JR. M.D. (DIRECTOR, MANAGER)
(858) 626-6362
Entity
Organization
Contact information
Practice address
9888 GENESEE AVE, LJ-601, LA JOLLA, CA 92037-1205
(858) 626-6362
(858) 626-6354
Mailing address
PO BOX 85466, SAN DIEGO, CA 92186-5466
(858) 626-6362
(858) 626-6354
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
C42394
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C423940
—
CA
Enumeration date
10/26/2007
Last updated
11/05/2007
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