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General NPI Number Information
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NPI Number | 1083702906
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Entity Type | Organization
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Legal Business Name | FRED R. SAMIMI, M.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 9108 LAGUNA MAIN ST SUITE 4
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City | ELK GROVE
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State | CA
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Zip | 95758-7450
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Country | US
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Telephone | 916-990-2828
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Fax | 866-728-8816
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Provider Business Mailing Address
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Address Line | 11230 GOLD EXPRESS DR SUITE 310-372
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City | GOLD RIVER
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State | CA
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Zip | 95670-4484
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Country | US
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Telephone | 916-572-8172
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FRED R. SAMIMI
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Credential | M.D.
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Telephone | 916-990-2828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | A83265
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License Number State | CA
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