1578776720 NPI number — DR. RODNEY ANTON SAMAAN MD

Table of content: DR. RODNEY ANTON SAMAAN MD (NPI 1578776720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578776720 NPI number — DR. RODNEY ANTON SAMAAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAMAAN
Provider First Name:
RODNEY
Provider Middle Name:
ANTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1578776720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5632 VAN NUYS BLVD
Provider Second Line Business Mailing Address:
SUITE 185
Provider Business Mailing Address City Name:
VAN NUYS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91401-4602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-906-4711
Provider Business Mailing Address Fax Number:
877-991-4121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14901 RINALDI ST
Provider Second Line Business Practice Location Address:
STE 335
Provider Business Practice Location Address City Name:
MISSION HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91345-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-906-4711
Provider Business Practice Location Address Fax Number:
877-991-4121
Provider Enumeration Date:
05/07/2007

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: 207RC0000X , with the licence number:  A119309 , 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: A119309 . This is a "CA LICENSE" identifier . This identifiers is of the category "OTHER".




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