Provider Demographics
NPI:1164795209
Name:NOSRATI, SAM (DPM)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:NOSRATI
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Gender:M
Credentials:DPM
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Mailing Address - Street 1:32565 B GOLDEN LANTERN STREET
Mailing Address - Street 2:PMB 341
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3261
Mailing Address - Country:US
Mailing Address - Phone:949-272-0007
Mailing Address - Fax:949-272-0006
Practice Address - Street 1:26800 CROWN VALLEY PKWY STE 420
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8023
Practice Address - Country:US
Practice Address - Phone:949-272-0007
Practice Address - Fax:949-272-0006
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2019-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAE4997213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery