Provider Demographics
NPI:1295483717
Name:PAULINO, SAMUEL BATIN JR
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:BATIN
Last Name:PAULINO
Suffix:JR
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 1:10500 RAINIER ST
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-4150
Mailing Address - Country:US
Mailing Address - Phone:818-915-8571
Mailing Address - Fax:
Practice Address - Street 1:10500 RAINIER ST
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-4150
Practice Address - Country:US
Practice Address - Phone:818-915-8571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist