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General NPI Number Information
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NPI Number | 1780063644
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Entity Type | Individual
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Provider Name | SAMUEL HERMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 26671 ALISO CREEK RD STE 206
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City | ALISO VIEJO
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State | CA
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Zip | 92656-4810
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Country | US
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Telephone | 949-791-3104
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Fax | 949-791-3181
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Provider Business Mailing Address
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Address Line | 26671 ALISO CREEK RD STE 206
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City | ALISO VIEJO
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State | CA
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Zip | 92656-4810
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Country | US
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Telephone | 949-791-3104
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Fax | 949-791-3181
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | DR.0068313
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 178008
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License Number State | CA
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