Individual
MAIRA E SIMENTAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
401 E HIGHLAND AVE, SAN BERNARDINO, CA 92404-3803
(909) 475-2700
(909) 475-2738
Mailing address
PO BOX 512185, LOS ANGELES, CA 90051-0185
(626) 775-3514
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
A67312
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A673120
—
CA
01
—
A67312
MEDICAL LICENSE
CA
01
—
P00296252
RR MEDICARE ST. BERNADINE
CA
Enumeration date
12/01/2005
Last updated
11/11/2020
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