Doctor Name: | DR. SIMON JESUS KASSIS |
NPI Number: | 1548410590 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 11608 |
Business Practice Address: | 708 Del Prado Blvd Suite 9 Cape Coral, FL - 339905616 |
Business Phone Number: | 2395745864 |
Business Fax Number: | 2395741451 |
Mailing Address: | 708 Del Prado Blvd, Suite 9 CAPE CORAL |
State: | FL |
Postal Code: | 339905616 |
Phone Number: | 2395745864 |
Fax Number: | 2395741451 |
NPI Enumeration Date: | 09/26/2008 |
NPI Last Update Date: | 11/08/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 11608 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |