Provider Demographics
NPI:1053285601
Name:SIMONETTI, ERICA MARIE
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:MARIE
Last Name:SIMONETTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 LEE DR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-1518
Mailing Address - Country:US
Mailing Address - Phone:541-294-1143
Mailing Address - Fax:
Practice Address - Street 1:7510 LEE DR
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-1518
Practice Address - Country:US
Practice Address - Phone:541-294-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical