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General NPI Number Information
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NPI Number | 1346712866
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Entity Type | Organization
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Legal Business Name | SIMONA DAVOUDPOUR DO A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/21/2018
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Last Update Date | 12/21/2018
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Provider Practice Location Address
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Address Line | 5757 WILSHIRE BLVD. PROMENADE 2
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City | LOS ANGELES
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State | CA
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Zip | 90036
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Country | US
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Telephone | 424-284-9027
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Fax |
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Provider Business Mailing Address
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Address Line | 1270 S ALFRED ST UNIT 351614
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City | LOS ANGELES
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State | CA
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Zip | 90035-8066
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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 | PRESIDENT
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Name | DR. SIMONA DAVOUDPOUR
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Credential | DO
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Telephone | 424-284-9027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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