Provider Demographics
NPI:1790846129
Name:DOCTOR, FEDERICO SAMORTIN JR (MD)
Entity Type:Individual
Prefix:
First Name:FEDERICO
Middle Name:SAMORTIN
Last Name:DOCTOR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8301 W CHARLESTON BLVD
Mailing Address - Street 2:APT.2066
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9068
Mailing Address - Country:US
Mailing Address - Phone:702-577-3027
Mailing Address - Fax:
Practice Address - Street 1:5342 DUDLEY BLVD
Practice Address - Street 2:
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652-1012
Practice Address - Country:US
Practice Address - Phone:916-561-7400
Practice Address - Fax:916-561-7405
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY242423207Q00000X
CAA101104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine