Provider Demographics
NPI:1225079460
Name:SAMILEY, ROMANITCHIKO (NP)
Entity Type:Individual
Prefix:MR
First Name:ROMANITCHIKO
Middle Name:
Last Name:SAMILEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 WILSHIRE BLVD BLDG 206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073-1003
Mailing Address - Country:US
Mailing Address - Phone:310-268-3946
Mailing Address - Fax:310-268-4828
Practice Address - Street 1:11301 WILSHIRE BLVD BLDG 206
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-268-3946
Practice Address - Fax:310-268-4828
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA538025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily