Healthcare Provider Details

I. General information

NPI: 1356608624
Provider Name (Legal Business Name): SAMANTHA LYNN MADRID M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA LYNN SUEY M.D.

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST BOX 10
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

2547 N STUDEBAKER RD
LONG BEACH CA
90815-2430
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-5067
  • Fax:
Mailing address:
  • Phone: 510-501-9172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA128623
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: