Provider Demographics
NPI:1942527692
Name:SAMRAS, NATHAN SLEETH (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:SLEETH
Last Name:SAMRAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 UCLA MEDICAL PLZ STE 490
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024
Practice Address - Country:US
Practice Address - Phone:310-206-8000
Practice Address - Fax:310-206-8005
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA146081208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003147649CMedicaid
GA003147649BMedicaid
GAP01343411OtherRAILROAD MEDICARE
GA003147649AMedicaid
SCGA1653Medicaid
GA003147649DMedicaid
GA202I116954Medicare PIN