Provider Demographics
NPI:1053476176
Name:VALENCIA, SIMON R (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:R
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1234 N VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1704
Mailing Address - Country:US
Mailing Address - Phone:323-660-5624
Mailing Address - Fax:323-660-5626
Practice Address - Street 1:1234 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1704
Practice Address - Country:US
Practice Address - Phone:323-660-5624
Practice Address - Fax:323-660-5626
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA29972207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3495616Medicaid
A84028Medicare UPIN
CA3495616Medicaid