MEDICARE: AMERICO A SIMONINI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	G37109	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639230766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMERICO A SIMONINI MD

Provider Business Mailing Address
First Line	:	640 S SAN VICENTE BLVD STE 498
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4884
Country	:	US
Telephone Number	:	310-425-0672
Fax Number	:	310-659-1369

Provider Business Practice Location Address
First Line	:	640 S SAN VICENTE BLVD STE 498
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4884
Country	:	US
Telephone Number	:	310-425-0672
Fax Number	:	310-659-1369

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/16/2021

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Directions to “ AMERICO A SIMONINI MD” Practice Location

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