Healthcare Provider Details

I. General information

NPI: 1265688311
Provider Name (Legal Business Name): SIMONA DAVOUDPOUR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST
LOS ANGELES CA
90048-6101
US

IV. Provider business mailing address

9001 WILSHIRE BLVD STE 306
BEVERLY HILLS CA
90211-1841
US

V. Phone/Fax

Practice location:
  • Phone: 310-385-3518
  • Fax:
Mailing address:
  • Phone: 818-265-2264
  • Fax: 818-265-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A10113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: