Provider Demographics
NPI:1699031450
Name:ABU-SAMRAH, ABDALLAH NAZMI (MD)
Entity Type:Individual
Prefix:
First Name:ABDALLAH
Middle Name:NAZMI
Last Name:ABU-SAMRAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ABDALLAH
Other - Middle Name:
Other - Last Name:ABUSAMRAH SALAIMEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7088 GASKIN PL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-5622
Mailing Address - Country:US
Mailing Address - Phone:951-231-7173
Mailing Address - Fax:
Practice Address - Street 1:1150 N INDIAN CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-778-5908
Practice Address - Fax:760-778-5904
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA136229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program