Healthcare Provider Details

I. General information

NPI: 1114140233
Provider Name (Legal Business Name): MARK NOEL SAMONTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22015 MAIN ST
CARSON CA
90745-2942
US

IV. Provider business mailing address

22015 MAIN ST STE B
CARSON CA
90745-2942
US

V. Phone/Fax

Practice location:
  • Phone: 949-375-1699
  • Fax: 818-924-4217
Mailing address:
  • Phone: 310-850-5630
  • Fax: 818-924-4217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA98537
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA98537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: