Provider Demographics
NPI:1356025480
Name:TROSSBACH, SIMON LEE (RPA)
Entity type:Individual
Prefix:MR
First Name:SIMON
Middle Name:LEE
Last Name:TROSSBACH
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74940 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4565
Mailing Address - Country:US
Mailing Address - Phone:303-242-2846
Mailing Address - Fax:
Practice Address - Street 1:72855 FRED WARING DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-9368
Practice Address - Country:US
Practice Address - Phone:760-837-1420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO06CO1216243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant