Basic Information
| Provider Information | |||||||||
| NPI: | 1316936933 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAROUDI | ||||||||
| FirstName: | SAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1926 VIA CTR | ||||||||
| Address2: | |||||||||
| City: | VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920816056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609407000 | ||||||||
| FaxNumber: | 7609400042 | ||||||||
| Practice Location | |||||||||
| Address1: | 1926 VIA CTR | ||||||||
| Address2: | |||||||||
| City: | VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920816056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609407000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2005 | ||||||||
| LastUpdateDate: | 09/15/2019 | ||||||||
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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 | 207R00000X | A67327 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | CB231242 | 01 | CA | MEDICARE | OTHER | P00174334 | 01 | CA | RAILROAD MEDICARE | OTHER |