Provider Demographics
NPI:1609172030
Name:SAFAEE, SAM (PA-C)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:SAFAEE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S MILLER ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5248
Mailing Address - Country:US
Mailing Address - Phone:805-314-2175
Mailing Address - Fax:805-314-2219
Practice Address - Street 1:201 S MILLER ST STE 103
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5248
Practice Address - Country:US
Practice Address - Phone:805-314-2175
Practice Address - Fax:805-314-2219
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21412363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA21412OtherPHYSICIAN ASSISTANT COMMITTEE LICENSE
CA12317742OtherCAQH PROVIDER NUMBER
CAPA21412OtherPHYSICIAN ASSISTANT COMMITTEE LICENSE
CAFA892WMedicare PIN
CAFA892XMedicare PIN