Healthcare Provider Details

I. General information

NPI: 1952856205
Provider Name (Legal Business Name): SANA ALEXANDROVNA NODELMAN DR. SAMUEL J. PORTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7224 HILLSIDE AVE 26
LOS ANGELES CA
90046-2359
US

IV. Provider business mailing address

7224 HILLSIDE AVE 26
LOS ANGELES CA
90046-2359
US

V. Phone/Fax

Practice location:
  • Phone: 323-327-2694
  • Fax:
Mailing address:
  • Phone: 323-327-2694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License NumberY2859416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: