Healthcare Provider Details

I. General information

NPI: 1407518418
Provider Name (Legal Business Name): AG SIMPLY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 03/03/2022
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 ERRINGER RD STE 217
SIMI VALLEY CA
93065-6510
US

IV. Provider business mailing address

1687 ERRINGER RD STE 217
SIMI VALLEY CA
93065-6510
US

V. Phone/Fax

Practice location:
  • Phone: 281-505-5680
  • Fax:
Mailing address:
  • Phone: 805-422-8131
  • Fax: 805-422-8037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: AMIT GUPTA
Title or Position: TRUSTEE
Credential: DO
Phone: 805-422-8131