Provider Demographics
NPI:1366418931
Name:SIMONI, AZITA (MD)
Entity type:Individual
Prefix:DR
First Name:AZITA
Middle Name:
Last Name:SIMONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:50 N LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2227
Mailing Address - Country:US
Mailing Address - Phone:310-889-4882
Mailing Address - Fax:516-623-9191
Practice Address - Street 1:425 HAALAND DR STE 204
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-5231
Practice Address - Country:US
Practice Address - Phone:805-497-8080
Practice Address - Fax:805-497-8806
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA101945207N00000X
NY224015207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3K3361Medicare PIN
I17498Medicare UPIN