=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578776720
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RODNEY ANTON SAMAAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2007
-----------------------------------------------------
Last Update Date | 04/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14901 RINALDI ST STE 335
-----------------------------------------------------
City | MISSION HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91345-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-906-4711
-----------------------------------------------------
Fax | 877-991-4121
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5632 VAN NUYS BLVD SUITE 185
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91401-4602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-906-4711
-----------------------------------------------------
Fax | 877-991-4121
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | A119309
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------