Healthcare Provider Details

I. General information

NPI: 1538320619
Provider Name (Legal Business Name): AMERICO SIMONINI, M.D.,PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST 750W
LOS ANGELES CA
90048-6101
US

IV. Provider business mailing address

8635 W 3RD ST 750W
LOS ANGELES CA
90048-6101
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-2030
  • Fax: 310-659-1369
Mailing address:
  • Phone: 310-659-2030
  • Fax: 310-659-1369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG73109
License Number StateCA

VIII. Authorized Official

Name: DR. AMERICO SIMONINI
Title or Position: PRESIDENT
Credential: MD
Phone: 310-659-2030