MEDICARE: NATALIE SAMIMI NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	95010336	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E1501046	OTHER	CA	DRIVERS LICENSE

General Provider Information

NPI Number	:	1033728563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE SAMIMI NP

Provider Business Mailing Address
First Line	:	5645 BLANCO AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-4008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23501 PARK SORRENTO STE 216
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-1383
Country	:	US
Telephone Number	:	818-222-7495
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2020
Last Update Date	:	07/30/2020

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