MEDICARE: SAMY METYAS, M.D., INC.

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	261QM2500X	Medical Specialty Clinic/Center	A72678	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942309745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMY METYAS, M.D., INC.

Provider Business Mailing Address
First Line	:	500 W SAN BERNARDINO RD STE A
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91722-3797
Country	:	US
Telephone Number	:	626-966-1909
Fax Number	:	626-966-2629

Provider Business Practice Location Address
First Line	:	500 W SAN BERNARDINO RD STE A
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91722-3797
Country	:	US
Telephone Number	:	626-966-1909
Fax Number	:	626-966-2629

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SAMY KAMAL METYAS
Credential	:	M.D.
Telephone Number	:	626-966-1909

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	12/26/2023

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