Provider Demographics
NPI:1679970511
Name:POWELL, SIMONE (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMONE
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SIMONE
Other - Middle Name:
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1050 LINDEN AVE
Mailing Address - Street 2:GME OFFICE
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3321
Mailing Address - Country:US
Mailing Address - Phone:562-491-9140
Mailing Address - Fax:562-491-9146
Practice Address - Street 1:1050 LINDEN AVE
Practice Address - Street 2:GME OFFICE
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3321
Practice Address - Country:US
Practice Address - Phone:562-491-9140
Practice Address - Fax:562-491-9146
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA143764207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine