Healthcare Provider Details

I. General information

NPI: 1720197932
Provider Name (Legal Business Name): NUNE SIMONIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N CENTRAL AVE #301
GLENDALE CA
91203-3358
US

IV. Provider business mailing address

540 N CENTRAL AVE #301
GLENDALE CA
91203-3358
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-3916
  • Fax: 818-242-4586
Mailing address:
  • Phone: 818-242-3916
  • Fax: 818-242-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA55410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: