Provider Demographics
NPI:1447660824
Name:RODNEY SAMAAN MD INC
Entity type:Organization
Organization Name:RODNEY SAMAAN MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:ANTON
Authorized Official - Last Name:SAMAAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-906-4711
Mailing Address - Street 1:5632 VAN NUYS BLVD STE 185
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-4602
Mailing Address - Country:US
Mailing Address - Phone:818-906-4711
Mailing Address - Fax:877-991-4121
Practice Address - Street 1:14901 RINALDI ST
Practice Address - Street 2:STE. 335
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1204
Practice Address - Country:US
Practice Address - Phone:818-906-4711
Practice Address - Fax:877-991-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119309207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB214209Medicare PIN