Healthcare Provider Details

I. General information

NPI: 1033164793
Provider Name (Legal Business Name): MARK S SAMBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MERCY AVE STE 400
MERCED CA
95340-8363
US

IV. Provider business mailing address

3400 DATA DR QUALITY DEPT., 2ND FL
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 209-564-3700
  • Fax: 209-564-3799
Mailing address:
  • Phone: 916-379-2861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG36285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: