Provider Demographics
NPI:1083702906
Name:FRED R. SAMIMI, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FRED R. SAMIMI, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAMIMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-990-2828
Mailing Address - Street 1:11230 GOLD EXPRESS DR
Mailing Address - Street 2:SUITE 310-372
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4484
Mailing Address - Country:US
Mailing Address - Phone:916-572-8172
Mailing Address - Fax:
Practice Address - Street 1:9108 LAGUNA MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7450
Practice Address - Country:US
Practice Address - Phone:916-990-2828
Practice Address - Fax:866-728-8816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA832652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H92724Medicare UPIN