Healthcare Provider Details

I. General information

NPI: 1659215424
Provider Name (Legal Business Name): AMERICO SIMONINI, M.D.,PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S SAN VICENTE BLVD STE 498
LOS ANGELES CA
90048-4884
US

IV. Provider business mailing address

PO BOX 27206
LOS ANGELES CA
90027-0206
US

V. Phone/Fax

Practice location:
  • Phone: 310-425-0672
  • Fax:
Mailing address:
  • Phone: 213-385-0675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: AMERICO A SIMONINI
Title or Position: OWNER
Credential: MD
Phone: 310-425-0672