1487328845 NPI number — MR. MAURICE BRADLEY SAMPSON III CTRC

Table of content: MR. MAURICE BRADLEY SAMPSON III CTRC (NPI 1487328845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487328845 NPI number — MR. MAURICE BRADLEY SAMPSON III CTRC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAMPSON
Provider First Name:
MAURICE
Provider Middle Name:
BRADLEY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
CTRC
Provider Gender Code:
M

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:
1487328845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5006 COOLIDGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CULVER CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90230-5176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-359-5894
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5006 COOLIDGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CULVER CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90230-5176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-359-5894
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171400000X , 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)





Copyright © 2007-2025 www.npivalidator.com