Basic Information
| Provider Information | |||||||||
| NPI: | 1396881207 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAMEH ELSANADI MD,INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9070 IRVINE CENTER DR | ||||||||
| Address2: | SUITE# 105 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926184678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495810881 | ||||||||
| FaxNumber: | 9495810911 | ||||||||
| Practice Location | |||||||||
| Address1: | 9070 IRVINE CENTER DR | ||||||||
| Address2: | SUITE# 105 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926184678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495810881 | ||||||||
| FaxNumber: | 9495810911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 09/11/2007 | ||||||||
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| AuthorizedOfficialLastName: | ELSANADI | ||||||||
| AuthorizedOfficialFirstName: | SAMEH | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE OWNER, PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9495810881 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0805X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry |
No ID Information.