Provider Demographics
NPI:1336979731
Name:SAPOLU, SIMOE ROSA
Entity type:Individual
Prefix:MS
First Name:SIMOE
Middle Name:ROSA
Last Name:SAPOLU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 REDONDO BEACH BLVD # C71
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-1683
Mailing Address - Country:US
Mailing Address - Phone:310-493-5762
Mailing Address - Fax:
Practice Address - Street 1:2100 REDONDO BEACH BLVD # C71
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-1683
Practice Address - Country:US
Practice Address - Phone:310-493-5762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32763225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist