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General NPI Number Information
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NPI Number | 1982792743
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Entity Type | Organization
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Legal Business Name | SAMARITAN ANESTHESIOLOGY MEDICAL GROUP
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 1225 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90017
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Country | US
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Telephone | 800-883-7243
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Fax |
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Provider Business Mailing Address
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Address Line | DEPT LA 24632
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City | PASADENA
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State | CA
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Zip | 91185-4632
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Country | US
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Telephone | 714-347-1010
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Fax | 714-347-1082
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | PETER PHAM
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Credential | MD
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Telephone | 714-418-3303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | FNP35151
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License Number State | CA
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