Provider Demographics
NPI:1871250845
Name:SAMUELIAN, NATALIE (PA-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:SAMUELIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16931 TUPPER ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91343-3542
Mailing Address - Country:US
Mailing Address - Phone:818-426-5683
Mailing Address - Fax:
Practice Address - Street 1:16931 TUPPER ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91343-3542
Practice Address - Country:US
Practice Address - Phone:818-426-5683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant