Provider Demographics
NPI:1952856205
Name:NODELMAN, SANA ALEXANDROVNA (DR SAMUEL J PORTER)
Entity Type:Individual
Prefix:MISS
First Name:SANA
Middle Name:ALEXANDROVNA
Last Name:NODELMAN
Suffix:
Gender:F
Credentials:DR SAMUEL J PORTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7224 HILLSIDE AVE
Mailing Address - Street 2:26
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-2359
Mailing Address - Country:US
Mailing Address - Phone:323-327-2694
Mailing Address - Fax:
Practice Address - Street 1:7224 HILLSIDE AVE
Practice Address - Street 2:26
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-2359
Practice Address - Country:US
Practice Address - Phone:323-327-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY2859416170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics