Healthcare Provider Details

I. General information

NPI: 1881053809
Provider Name (Legal Business Name): AMANUEL SIMA MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N LA CIENEGA BLVD SUITE 220
BEVERLY HILLS CA
90211-2227
US

IV. Provider business mailing address

50 N LA CIENEGA BLVD SUITE 220
BEVERLY HILLS CA
90211-2227
US

V. Phone/Fax

Practice location:
  • Phone: 310-855-0556
  • Fax: 310-419-9475
Mailing address:
  • Phone: 310-855-0556
  • Fax: 310-419-9475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMANUEL SIMA
Title or Position: PRESIDENT
Credential: MD
Phone: 310-855-0556