Provider Demographics
NPI:1447361324
Name:SAMARA PALACIO CARDENAS M.D. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SAMARA PALACIO CARDENAS M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMARA
Authorized Official - Middle Name:PALACIO
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-535-6419
Mailing Address - Street 1:1120 W LA PALMA AVE
Mailing Address - Street 2:#15
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2801
Mailing Address - Country:US
Mailing Address - Phone:714-535-6419
Mailing Address - Fax:714-535-7222
Practice Address - Street 1:1120 W LA PALMA AVE
Practice Address - Street 2:#15
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2801
Practice Address - Country:US
Practice Address - Phone:714-535-6419
Practice Address - Fax:714-535-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30768261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A307680Medicaid