MEDICARE: MR. ARSHAD AZIZ SAMAD PA-C

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	363AM0700X	Medical Physician Assistant	PA20582	CA

General Provider Information

NPI Number	:	1831424506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARSHAD AZIZ SAMAD PA-C

Provider Business Mailing Address
First Line	:	11911 CENTRAL AVE
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-1906
Country	:	US
Telephone Number	:	951-640-9592
Fax Number	:

Provider Business Practice Location Address
First Line	:	18300 HIGHWAY 18
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-0725
Country	:	US
Telephone Number	:	760-242-2311
Fax Number	:

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

Provider Enumeration Date	:	10/13/2009
Last Update Date	:	11/23/2021

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