Simi Medical Group, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G29685 Issued in CA

Legal business name

SIMI MEDICAL GROUP, INC

Practice address

2755 Alamo St Ste 101
Simi Valley, CA 93065-1311

Phone

(805) 210-7280

Fax

(802) 210-7281

NPI assigned

Sep 1, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Izela Juanita Guerra

Title

Manager

Phone

(951) 205-1192

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William Ang Lee, MD

  • Internal Medicine Physician
  • Simi Valley, CA
  • NPI 1619960705
  Medicare reassignment Care Compare group NPD
• Richard Mark Shaw, MD

  • Family Medicine Physician
  • Simi Valley, CA
  • NPI 1376537753
  Medicare reassignment Care Compare group NPD
• Kevin Breck Westbrook, M.D.

  • Family Medicine Physician
  • Simi Valley, CA
  • NPI 1508445859
  Medicare reassignment Care Compare group NPD (past)
• Ashley Tashelle Crisostomo, FNP

  • Family Nurse Practitioner
  • Oxnard, CA
  • NPI 1356862791
  Medicare reassignment NPD
• Mine Moosakhanian, FNP-C

  • Primary Care Nurse Practitioner
  • Simi Valley, CA
  • NPI 1881310761
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504224000000",
    "number": "1346768025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 W 11TH ST",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917863702",
            "telephone_number": "951-205-1192",
            "fax_number": "909-985-9772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2755 ALAMO ST STE 101",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651311",
            "telephone_number": "805-210-7280",
            "fax_number": "802-210-7281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMI MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-01",
        "last_updated": "2017-09-01",
        "status": "A",
        "authorized_official_last_name": "GUERRA",
        "authorized_official_first_name": "IZELA",
        "authorized_official_middle_name": "JUANITA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "951-205-1192",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G29685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Simi Dermatologic Medical Center, Inc
• Simi Dialysis Center, LLC
• Simi Family Medical Group
• Simi Health Center a Medical Corp
• Simi Hills Home Care Center LLC
• Simi Oaks Inc.
• Simi Obstetrics & Gynecology Medical Group a Medical Corp.
• Simi Plaza Home Care Inc
• Simi Primary Care Medical Group Inc
• Simi Psychological Group, Apc

• Family Medicine Physician in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.