MEDICARE: DR. MARK NOEL SAMONTE M.D.

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	174400000X	Specialist	A98537	CA
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	A98537	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	STATE LICENSE	OTHER	CA	A98537

General Provider Information

NPI Number	:	1114140233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK NOEL SAMONTE M.D.

Provider Business Mailing Address
First Line	:	23049 ARCHIBALD AVE
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90745-4718
Country	:	US
Telephone Number	:	310-830-1526
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 E BEVERLY BLVD STE 100A
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-4314
Country	:	US
Telephone Number	:	310-830-1526
Fax Number	:

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	03/28/2017

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