Provider Demographics
NPI:1760845101
Name:SIMONE, AGNES (DO)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:SIMONE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11209 NATIONAL BLVD UNIT 1112
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3902
Mailing Address - Country:US
Mailing Address - Phone:424-401-5368
Mailing Address - Fax:
Practice Address - Street 1:11209 NATIONAL BLVD UNIT 1112
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-3902
Practice Address - Country:US
Practice Address - Phone:424-401-5368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-02
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A158332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty