MEDICARE: ELI SIMSOLO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	1013663	MA
2	207R00000X	Internal Medicine Physician	A186821	CA
3	207RC0000X	Cardiovascular Disease Physician	1013663	MA
4	207RC0000X	Cardiovascular Disease Physician	A186821	CA
5	207RC0001X	Clinical Cardiac Electrophysiology Physician	A186821	CA

General Provider Information

NPI Number	:	1811420458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELI SIMSOLO M.D.

Provider Business Mailing Address
First Line	:	8631 W 3RD ST STE 710E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5911
Country	:	US
Telephone Number	:	310-746-5335
Fax Number	:	310-499-0025

Provider Business Practice Location Address
First Line	:	8631 W 3RD ST STE 710E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5911
Country	:	US
Telephone Number	:	310-746-5335
Fax Number	:	310-499-0025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	05/25/2025

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