Provider Demographics
NPI:1750443198
Name:DOOLITTLE, SAMUEL W (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:W
Last Name:DOOLITTLE
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 1:1480 S HARBOR BLVD
Mailing Address - Street 2:STE 12
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-7569
Mailing Address - Country:US
Mailing Address - Phone:714-871-3255
Mailing Address - Fax:714-870-2038
Practice Address - Street 1:1480 S HARBOR BLVD
Practice Address - Street 2:STE 12
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-7569
Practice Address - Country:US
Practice Address - Phone:714-871-3255
Practice Address - Fax:714-870-2038
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27746207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G277460Medicaid
CA00G277460Medicaid
CA00G277460Medicaid
CA4158530001Medicare NSC
AD6473261OtherDRUG ENFORCEMENT AGENCY