Healthcare Provider Details

I. General information

NPI: 1255433082
Provider Name (Legal Business Name): SAMUEL SAMALIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7765 LEEDS ST
DOWNEY CA
90242-3489
US

IV. Provider business mailing address

600 W 9TH ST APT 510
LOS ANGELES CA
90015-4314
US

V. Phone/Fax

Practice location:
  • Phone: 844-804-1933
  • Fax:
Mailing address:
  • Phone: 213-308-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011123
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18434
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: