Healthcare Provider Details

I. General information

NPI: 1174686372
Provider Name (Legal Business Name): SIMI WOMENS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E LOS ANGELES AVE #202
SIMI VALLEY CA
93065
US

IV. Provider business mailing address

1350 E LOS ANGELES AVE #202
SIMI VALLEY CA
93065
US

V. Phone/Fax

Practice location:
  • Phone: 805-584-1633
  • Fax: 805-584-1641
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA39786
License Number StateCA

VIII. Authorized Official

Name: PAULETTE YSAIS
Title or Position: PRESIDENT
Credential: NURSE PRACTITIONER
Phone: 805-584-1633