Healthcare Provider Details

I. General information

NPI: 1417187618
Provider Name (Legal Business Name): BETH LYNN ROYAL SIMATI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43500 RIDGE PARK DR
TEMECULA CA
92590-3624
US

IV. Provider business mailing address

PO BOX 555191 200 MERCY CIRCLE
OCEANSIDE CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 951-308-2200
  • Fax: 760-763-0671
Mailing address:
  • Phone: 951-308-2200
  • Fax: 760-763-0671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60115754
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.205031
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number70428
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC156596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: