Healthcare Provider Details

I. General information

NPI: 1871810374
Provider Name (Legal Business Name): STEPHAN SIMONIAN MD APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 N BRAND BLVD SUITE # 306
GLENDALE CA
91202-2511
US

IV. Provider business mailing address

1141 N BRAND BLVD SUITE # 306
GLENDALE CA
91202-2511
US

V. Phone/Fax

Practice location:
  • Phone: 818-551-1118
  • Fax: 818-551-1955
Mailing address:
  • Phone: 818-551-1118
  • Fax: 818-551-1955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHAN SIMONIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-551-1118