Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | G72126 | CA |
Y | 207QS0010X | Family Doctor - Sports Medicine | G72126 | PA |
NPI | 1033137013 |
---|---|
Provider Name | Lauren Simon |
First Address | Los Angeles, CA 90074-4701 |
Second Address | Loma Linda, CA 92354-3128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 09/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G721260 | (05) | CA |
F07394 | (02) |