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General NPI Number Information
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NPI Number | 1033268503
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Entity Type | Individual
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Provider Name | ELLIE E SAMADANI M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 12/21/2009
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Provider Practice Location Address
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Address Line | 3737 MORAGA AVE SUITE A105
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City | SAN DIEGO
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State | CA
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Zip | 92117-5404
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Country | US
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Telephone | 858-273-0200
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Fax | 858-273-0619
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Provider Business Mailing Address
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Address Line | 3737 MORAGA AVE SUITE A105
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City | SAN DIEGO
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State | CA
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Zip | 92117-5404
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Country | US
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Telephone | 858-273-0200
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Fax | 858-273-0619
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G83066
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License Number State | CA
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