Provider Demographics
NPI:1720197932
Name:SIMONIAN, NUNE (MD)
Entity Type:Individual
Prefix:
First Name:NUNE
Middle Name:
Last Name:SIMONIAN
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 1:540 N CENTRAL AVE
Mailing Address - Street 2:#301
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3358
Mailing Address - Country:US
Mailing Address - Phone:818-242-3916
Mailing Address - Fax:818-242-4586
Practice Address - Street 1:540 N CENTRAL AVE
Practice Address - Street 2:#301
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3358
Practice Address - Country:US
Practice Address - Phone:818-242-3916
Practice Address - Fax:818-242-4586
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55410208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A554102Medicaid