Provider Demographics
NPI:1205003779
Name:SIMOVITCH, LOREN ELYSE
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:ELYSE
Last Name:SIMOVITCH
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:LOREN
Other - Middle Name:ELYSE
Other - Last Name:SIMOVITCH-LINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6274 LINTON BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6508
Mailing Address - Country:US
Mailing Address - Phone:561-638-7668
Mailing Address - Fax:
Practice Address - Street 1:6274 LINTON BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6508
Practice Address - Country:US
Practice Address - Phone:561-638-7668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82963208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics