Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | A29972 | CA |
NPI | 1053476176 |
---|---|
Provider Name | Dr. Simon R Valencia |
First Address | Los Angeles, CA 90029-1704 |
Second Address | Los Angeles, CA 90029-1704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3495616 | (05) | CA |
A84028 | (02) |