Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | G36285 | CA |
NPI | 1033164793 |
---|---|
Provider Name | Mr. Mark S Samberg |
First Address | Rancho Cordova, CA 95670-7956 |
Second Address | Merced, CA 95340-8363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 21/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G362850 | (05) | CA |
A46634 | (02) |