Provider Demographics
NPI:1912358680
Name:SAMUEL, CARLENE MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLENE
Middle Name:MICHELLE
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 PINTO LN
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4195
Mailing Address - Country:US
Mailing Address - Phone:702-671-2236
Mailing Address - Fax:702-671-2233
Practice Address - Street 1:1524 PINTO LN
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4195
Practice Address - Country:US
Practice Address - Phone:702-671-2236
Practice Address - Fax:702-671-2233
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program