Provider Demographics
NPI:1114140233
Name:SAMONTE, MARK NOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:NOEL
Last Name:SAMONTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23049 ARCHIBALD AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-4718
Mailing Address - Country:US
Mailing Address - Phone:310-830-1526
Mailing Address - Fax:
Practice Address - Street 1:101 E BEVERLY BLVD STE 100A
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4314
Practice Address - Country:US
Practice Address - Phone:310-830-1526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98537174400000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASTATE LICENSEOtherA98537