Provider Information for 1790836542
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Mr. ADRIAN JINKICHI SIMMONS LMFT
Sex: Male
NPI: 1790836542
Last Updated: 2020-04-15
Certification Date: 2020-04-15
Certification Date: 2020-04-15
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1790836542 | ||||||||||||
| Enumeration Date | 2007-01-16 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 8849 SVL BOX VICTORVILLE, CA 92395-5131 United States Phone: 760-508-1075 | Fax: | ||||||||||||
| Primary Practice Address | 15409 ANACAPA RD STE F VICTORVILLE, CA 92392-2463 United States Phone: 760-508-1075 | Fax: | ||||||||||||
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