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General NPI Number Information
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NPI Number | 1194214171
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Entity Type | Individual
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Provider Name | LAURA DIANE SIMPLER
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Gender | Female
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Dates
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Enumeration Date | 05/06/2018
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 1919 SANTA MONICA BLVD STE 210
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City | SANTA MONICA
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State | CA
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Zip | 90404-1970
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Country | US
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Telephone | 424-315-2327
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Fax | 424-315-2328
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Provider Business Mailing Address
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Address Line | 8700 BEVERLY BLVD STE 5512
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90048-1804
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A167356
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License Number State | CA
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