Provider Demographics
NPI:1417187618
Name:SIMATI, BETH LYNN ROYAL (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:LYNN ROYAL
Last Name:SIMATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 555191
Mailing Address - Street 2:200 MERCY CIRCLE
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92055
Mailing Address - Country:US
Mailing Address - Phone:951-308-2200
Mailing Address - Fax:760-763-0671
Practice Address - Street 1:43500 RIDGE PARK DR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3624
Practice Address - Country:US
Practice Address - Phone:951-308-2200
Practice Address - Fax:760-763-0671
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.205031207Q00000X
WAMD60115754207Q00000X
GA70428207Q00000X
CAC156596207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2169696Medicaid
MS02709849Medicaid
LA2169696Medicaid