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General NPI Number Information
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NPI Number | 1952413114
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Entity Type | Individual
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Provider Name | MOHAMMAD Y SAMARA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 6540 REFLECTION DR APT 1410
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City | SAN DIEGO
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State | CA
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Zip | 92124-5143
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Country | US
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Telephone | 414-793-0115
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Fax | 414-246-4198
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Provider Business Mailing Address
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Address Line | 6540 REFLECTION DR APT 1410
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City | SAN DIEGO
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State | CA
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Zip | 92124-5143
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Country | US
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Telephone | 414-793-0115
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Fax | 414-246-4198
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | C171319
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License Number State | CA
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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 | 36801
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License Number State | WI
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