Provider Demographics
NPI:1639230766
Name:SIMONINI, AMERICO A (MD)
Entity Type:Individual
Prefix:
First Name:AMERICO
Middle Name:A
Last Name:SIMONINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 S SAN VICENTE BLVD STE 498
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4884
Mailing Address - Country:US
Mailing Address - Phone:310-425-0672
Mailing Address - Fax:310-659-1369
Practice Address - Street 1:640 S SAN VICENTE BLVD STE 498
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4884
Practice Address - Country:US
Practice Address - Phone:310-425-0672
Practice Address - Fax:310-659-1369
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37109207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G73109Medicaid
F25030Medicare UPIN
CAG73109Medicare PIN