1124040076 NPI number — RAMIN SAMADI, MD INC

Table of content: MS. EMALEIGH SUZETTE POIROUX RBT (NPI 1295511285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124040076 NPI number — RAMIN SAMADI, MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAMIN SAMADI, MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124040076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 55007
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALENCIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91385-0007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-914-9150
Provider Business Mailing Address Fax Number:
310-914-9705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27420 TOURNEY RD STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALENCIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91355-5634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-914-9150
Provider Business Practice Location Address Fax Number:
310-914-9705
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAMADI
Authorized Official First Name:
RAMIN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
310-914-9150

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X , with the licence number:  G79027 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G790270 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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