Provider Demographics
NPI:1891277596
Name:SAMATRA, JOEL CALING
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:CALING
Last Name:SAMATRA
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 1:800 MEMORIAL DR APT 45
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3309
Mailing Address - Country:US
Mailing Address - Phone:650-303-5619
Mailing Address - Fax:
Practice Address - Street 1:800 MEMORIAL DR APT 45
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3309
Practice Address - Country:US
Practice Address - Phone:650-303-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4111054343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA82-4490608OtherIRS