Healthcare Provider Details

I. General information

NPI: 1548590623
Provider Name (Legal Business Name): DOROTHY MENESES-SAMSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 SEQUOIA AVE
LINDSAY CA
93247-1425
US

IV. Provider business mailing address

305 EAST CENTER AVE.
VISALIA CA
93291-6331
US

V. Phone/Fax

Practice location:
  • Phone: 866-707-6664
  • Fax: 661-746-9197
Mailing address:
  • Phone: 559-737-4700
  • Fax: 559-737-4782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA110320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: