Provider Demographics
NPI:1457379372
Name:DAMANI, SAMIR B (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:B
Last Name:DAMANI
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 1:9850 GENESEE AVE
Mailing Address - Street 2:SUITE 730
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-847-5064
Mailing Address - Fax:858-433-4099
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 730
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-847-5064
Practice Address - Fax:858-433-4099
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88989207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A889890Medicaid
CAWA88989AMedicare PIN
CA00A889890Medicaid
CAI59583Medicare UPIN