Provider Demographics
NPI:1316225436
Name:SAMOUH, ROMEO (MD)
Entity Type:Individual
Prefix:
First Name:ROMEO
Middle Name:
Last Name:SAMOUH
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 1:811 E 11TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4871
Mailing Address - Country:US
Mailing Address - Phone:909-360-8737
Mailing Address - Fax:909-377-5302
Practice Address - Street 1:811 E 11TH ST
Practice Address - Street 2:STE 102
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4871
Practice Address - Country:US
Practice Address - Phone:909-360-8737
Practice Address - Fax:909-377-5302
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA127159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine