| Simi Medical Group, Inc | |
|
2755 Alamo St Ste 101 Simi Valley CA 93065-1311 | |
| (805) 210-7280 | |
| (802) 210-7281 |
| Full Name | Simi Medical Group, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 2755 Alamo St Ste 101, Simi Valley, California |
| Authorized Official Name and Position | Izela Juanita Guerra (MANAGER) |
| Authorized Official Contact | 9512051192 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Simi Medical Group, Inc 904 W 11th St Upland CA 91786-3702 Ph: (951) 205-1192 | Simi Medical Group, Inc 2755 Alamo St Ste 101 Simi Valley CA 93065-1311 Ph: (805) 210-7280 |
| NPI Number | 1346768025 |
|---|---|
| Provider Enumeration Date | 09/01/2017 |
| Last Update Date | 09/01/2017 |
| Medicare PECOS PAC ID | 8820351786 |
|---|---|
| Medicare Enrollment ID | O20180406001689 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346768025 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G29685 (California) | Primary |
| Provider Name | William A Lee |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619960705 PECOS PAC ID: 4284682659 Enrollment ID: I20050112000459 |
| Provider Name | Harry Drummond |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164416517 PECOS PAC ID: 8022175819 Enrollment ID: I20090323000300 |
| Provider Name | Richard M Shaw |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376537753 PECOS PAC ID: 1759438062 Enrollment ID: I20090402000230 |
| Provider Name | Ashley T Crisostomo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356862791 PECOS PAC ID: 7113299157 Enrollment ID: I20170825000472 |
| Provider Name | Hyesu Shin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437516614 PECOS PAC ID: 4385073519 Enrollment ID: I20200821000284 |
| Provider Name | Bryana Gamido |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013363316 PECOS PAC ID: 4688003981 Enrollment ID: I20200829000103 |
| Provider Name | Mine Moosakhanian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881310761 PECOS PAC ID: 4284095019 Enrollment ID: I20230726003030 |
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