Individual provider Active NPI

Agnes Simone, D.O.

  • Psychiatry Physician
  • Los Angeles, CA
National Provider Identifier
1760845101
Registry record updated Jan 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
20A15833 Issued in CA
Practice address
11209 National Blvd Unit 1112
Los Angeles, CA 90064-3902
Phone
(424) 401-5368
NPI assigned
Apr 2, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 28, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 20A15833 CA Primary

Addresses

Primary practice location

11209 National Blvd Unit 1112
Los Angeles, CA 90064-3902

Mailing address

11209 National Blvd Unit 1112
Los Angeles, CA 90064-3902
Phone (424) 401-5368

Other practice location 1

2615 Pch Hwy Ste 215
Hermosa Beach, CA 90254-2228
Phone (424) 401-5368

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Nov 17, 2021 through Nov 17, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A15833CAMDPsychiatry Physician

NPI Registry JSON

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

{
    "created_epoch": "1459555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769558400000",
    "number": "1760845101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11209 NATIONAL BLVD UNIT 1112",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900643902",
            "telephone_number": "424-401-5368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11209 NATIONAL BLVD UNIT 1112",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900643902",
            "telephone_number": "424-401-5368"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2615 Pch Hwy Ste 215",
            "address_purpose": "LOCATION",
            "city": "Hermosa Beach",
            "state": "CA",
            "postal_code": "902542228",
            "country_code": "US",
            "telephone_number": "424-401-5368",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMONE",
        "first_name": "AGNES",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-02",
        "last_updated": "2026-01-28",
        "certification_date": "2026-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "20A15833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.