Healthcare Provider Details

I. General information

NPI: 1124659685
Provider Name (Legal Business Name): FIJI SIMMONS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11150 W OLYMPIC BLVD STE 780
LOS ANGELES CA
90064-1829
US

IV. Provider business mailing address

1218 E DEERFIELD CT
ONTARIO CA
91761-7041
US

V. Phone/Fax

Practice location:
  • Phone: 213-721-1571
  • Fax: 213-721-1578
Mailing address:
  • Phone: 909-313-1952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10009898
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number671631
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95016622
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95016622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: