Provider Demographics
NPI:1558875021
Name:SIMI PRIMARY CARE MEDICAL GROUP INC
Entity type:Organization
Organization Name:SIMI PRIMARY CARE MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RABIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKJOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-985-0443
Mailing Address - Street 1:2755 ALAMO ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2755 ALAMO ST STE 100
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1345
Practice Address - Country:US
Practice Address - Phone:310-985-0443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care