Provider Demographics
NPI:1558325563
Name:SAMUELS, ANDREW G (DPM)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:G
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-6756
Mailing Address - Country:US
Mailing Address - Phone:805-483-7799
Mailing Address - Fax:805-487-4841
Practice Address - Street 1:945 W 7TH ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6756
Practice Address - Country:US
Practice Address - Phone:805-483-7799
Practice Address - Fax:805-487-4841
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2978213E00000X
CARHC120923213ER0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E29780Medicaid
CAT19264Medicare UPIN
CA000E29780Medicaid
CAE2978BMedicare ID - Type Unspecified