Healthcare Provider Details

I. General information

NPI: 1770814030
Provider Name (Legal Business Name): DR STEVEN SAMPSON MED CORP-GEN PTR OF ORTHOHEALING MED PTRSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10780 SANTA MONICA BLVD SUITE # 210
LOS ANGELES CA
90025-4749
US

IV. Provider business mailing address

10780 SANTA MONICA BLVD #210
LOS ANGELES CA
90025-4749
US

V. Phone/Fax

Practice location:
  • Phone: 310-453-5404
  • Fax: 310-453-2535
Mailing address:
  • Phone: 310-453-5404
  • Fax: 310-453-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN SAMPSON
Title or Position: PARTNER
Credential: D.O.
Phone: 310-453-5404