Provider Demographics
NPI:1871682096
Name:SIMI HEALTH CENTER A MEDICAL CORP
Entity Type:Organization
Organization Name:SIMI HEALTH CENTER A MEDICAL CORP
Other - Org Name:C.R.J M.D. A MEDICAL CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDRASHEKHAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-522-3782
Mailing Address - Street 1:1350 E LOS ANGELES AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2898
Mailing Address - Country:US
Mailing Address - Phone:805-522-3782
Mailing Address - Fax:805-522-1283
Practice Address - Street 1:1350 E LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2898
Practice Address - Country:US
Practice Address - Phone:805-522-3782
Practice Address - Fax:805-522-1283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A255620Medicaid
CAW5213Medicare ID - Type Unspecified
CAA24493Medicare UPIN
CA00A255620Medicaid