Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | G67315 | CA |
N | 207RI0011X | Interventional Cardiology | G67315 | CA |
NPI | 1083686372 |
---|---|
Provider Name | Dr. Bruce A Samuels |
First Address | Beverly Hills, CA 90210-4532 |
Second Address | Beverly Hills, CA 90210-4532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 14/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G673150 | (05) | CA |
F11909 | (02) | CA |