Healthcare Provider Details

I. General information

NPI: 1902739352
Provider Name (Legal Business Name): SIMONE HARLOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 WILSHIRE BLVD., #410
SYLMAR CA
91342-4674
US

IV. Provider business mailing address

12515 RALSTON AVE UNIT 2
SYLMAR CA
91342-4674
US

V. Phone/Fax

Practice location:
  • Phone: 661-795-1633
  • Fax:
Mailing address:
  • Phone: 661-795-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number36823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: