Provider Demographics
NPI:1801002969
Name:SIMOPOULOS, ALEXANDER FORIS (MD)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:FORIS
Last Name:SIMOPOULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9201 W SUNSET BLVD
Mailing Address - Street 2:405
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3701
Mailing Address - Country:US
Mailing Address - Phone:310-859-9052
Mailing Address - Fax:310-859-1792
Practice Address - Street 1:9201 W SUNSET BLVD
Practice Address - Street 2:405
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-3701
Practice Address - Country:US
Practice Address - Phone:310-859-9052
Practice Address - Fax:310-859-1792
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96493174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist