Healthcare Provider Details

I. General information

NPI: 1306181375
Provider Name (Legal Business Name): SIMPLEDEEP BANIPAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 04/13/2025
Certification Date: 04/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 MAGNOLIA AVE
RIVERSIDE CA
92505-3043
US

IV. Provider business mailing address

12791 BLUSH CT
RIVERSIDE CA
92503-7008
US

V. Phone/Fax

Practice location:
  • Phone: 951-353-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125057681
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA154251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: