Healthcare Provider Details

I. General information

NPI: 1093164170
Provider Name (Legal Business Name): SAMER ROUMANI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8372 BARNWOOD LN
RIVERSIDE CA
92508-7113
US

IV. Provider business mailing address

3646 LONG BEACH BLVD STE 210
LONG BEACH CA
90807-6034
US

V. Phone/Fax

Practice location:
  • Phone: 949-371-6043
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A17184
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20A17184
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A17184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: