Provider Demographics
NPI:1821059924
Name:HAGE, SAMIR E (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:E
Last Name:HAGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:255 TERRACINA BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4870
Mailing Address - Country:US
Mailing Address - Phone:909-748-6065
Mailing Address - Fax:909-748-6095
Practice Address - Street 1:255 TERRACINA BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4870
Practice Address - Country:US
Practice Address - Phone:909-748-6065
Practice Address - Fax:909-748-6095
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7233207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A7233Medicaid
CA20A7233Medicaid
H53928Medicare UPIN