Healthcare Provider Details

I. General information

NPI: 1720196256
Provider Name (Legal Business Name): SAMUEL BAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 BENTON ST 111H
LOMA LINDA CA
92357-1000
US

IV. Provider business mailing address

111/11 INPATIENT MEDICINE HCG 5901 E 7TH STREET
LONG BEACH CA
90822-5201
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax: 909-777-3280
Mailing address:
  • Phone: 562-826-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA067115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: