Provider Demographics
NPI:1710441084
Name:FLEITMAN, SAMUEL MARTIN
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:MARTIN
Last Name:FLEITMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25591 PACIFIC CREST DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5050
Mailing Address - Country:US
Mailing Address - Phone:949-584-3470
Mailing Address - Fax:
Practice Address - Street 1:25591 PACIFIC CREST DR
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-5050
Practice Address - Country:US
Practice Address - Phone:949-584-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty