Healthcare Provider Details

I. General information

NPI: 1376615401
Provider Name (Legal Business Name): SAMIA ATEIA MD INC BALDWIN MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14135 FRANCISQUITO AVE SUITE#106
BALDWIN PARK CA
91706-6107
US

IV. Provider business mailing address

14135 FRANCISQUITO AVE SUITE#106
BALDWIN PARK CA
91706-6107
US

V. Phone/Fax

Practice location:
  • Phone: 626-960-3753
  • Fax: 626-962-9866
Mailing address:
  • Phone: 626-960-3753
  • Fax: 626-962-9866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number208000000X
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number207V00000X
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. NASHAT N. ATEIA
Title or Position: OFFICER
Credential: M.D.
Phone: 626-960-3753