Healthcare Provider Details

I. General information

NPI: 1811420458
Provider Name (Legal Business Name): ELI SIMSOLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 05/25/2025
Certification Date: 05/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST STE 710E
LOS ANGELES CA
90048-5911
US

IV. Provider business mailing address

8631 W 3RD ST STE 710E
LOS ANGELES CA
90048-5911
US

V. Phone/Fax

Practice location:
  • Phone: 310-746-5335
  • Fax: 310-499-0025
Mailing address:
  • Phone: 310-746-5335
  • Fax: 310-499-0025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1013663
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA186821
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number1013663
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA186821
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA186821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: