Basic Information
| Provider Information | |||||||||
| NPI: | 1184885873 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMOURJIAN | ||||||||
| FirstName: | EDWARD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2637 SHADELANDS DR | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945982512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259488143 | ||||||||
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| Practice Location | |||||||||
| Address1: | 820 S AKERS ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932778306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596254118 | ||||||||
| FaxNumber: | 5596256004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2008 | ||||||||
| LastUpdateDate: | 08/31/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | A113601 | CA | N | Allopathic & Osteopathic Physicians | General Practice | 390200000X | LL1864 | NV | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2086S0129X | A113601 | CA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.