1083702906 NPI number — FRED R. SAMIMI, M.D., A PROFESSIONAL CORPORATION

Table of content: (NPI 1083702906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083702906 NPI number — FRED R. SAMIMI, M.D., A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRED R. SAMIMI, M.D., A PROFESSIONAL CORPORATION
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:
1083702906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11230 GOLD EXPRESS DR
Provider Second Line Business Mailing Address:
SUITE 310-372
Provider Business Mailing Address City Name:
GOLD RIVER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95670-4484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-572-8172
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9108 LAGUNA MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95758-7450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-990-2828
Provider Business Practice Location Address Fax Number:
866-728-8816
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAMIMI
Authorized Official First Name:
FRED
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
916-990-2828

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  A83265 , 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)





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