Provider Demographics
NPI:1952303414
Name:MOURANI, SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:MOURANI
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 1:488 E SANTA CLARA ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7231
Mailing Address - Country:US
Mailing Address - Phone:626-359-3330
Mailing Address - Fax:626-359-3339
Practice Address - Street 1:488 E SANTA CLARA ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-7231
Practice Address - Country:US
Practice Address - Phone:626-359-3330
Practice Address - Fax:626-359-3339
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A511620Medicaid
CAA51162BMedicare PIN
CA00A511620Medicaid