Healthcare Provider Details

I. General information

NPI: 1952303414
Provider Name (Legal Business Name): SAMUEL MOURANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 E SANTA CLARA ST SUITE 103
ARCADIA CA
91006-7231
US

IV. Provider business mailing address

488 E SANTA CLARA ST SUITE 103
ARCADIA CA
91006-7231
US

V. Phone/Fax

Practice location:
  • Phone: 626-359-3330
  • Fax: 626-359-3339
Mailing address:
  • Phone: 626-359-3330
  • Fax: 626-359-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA51162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: