Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E2978 | CA |
Y | 222Z00000X | Podiatrist | E2978 | CA |
N | 111NR0200X | Radiology | RHC120923 | CA |
N | 213ER0200X | Radiology | RHC120923 | CA |
NPI | 1558325563 |
---|---|
Provider Name | Andrew G. Samuels |
First Address | Oxnard, CA 93030-6756 |
Second Address | Oxnard, CA 93030-6756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 21/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E29780 | (05) | CA |
T19264 | (02) | CA |