Provider Demographics
NPI:1134788854
Name:KOUOMEGNE-SIMO, ORNELLA ESTELLE (MD)
Entity type:Individual
Prefix:DR
First Name:ORNELLA
Middle Name:ESTELLE
Last Name:KOUOMEGNE-SIMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N MARIO CAPECCHI DR RM 3N100
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112
Mailing Address - Country:US
Mailing Address - Phone:801-581-2121
Mailing Address - Fax:
Practice Address - Street 1:30 N MARIO CAPECCHI DR RM 3N100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112
Practice Address - Country:US
Practice Address - Phone:801-581-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN390200000X
390200000X
UT14225369-1205207RM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program