Provider Demographics
NPI:1770591802
Name:ALAITI, SAMER (MD)
Entity type:Individual
Prefix:DR
First Name:SAMER
Middle Name:
Last Name:ALAITI
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 1:1100 S LA CIENEGA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2519
Mailing Address - Country:US
Mailing Address - Phone:323-938-2626
Mailing Address - Fax:323-938-2493
Practice Address - Street 1:6200 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1502
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5801
Practice Address - Country:US
Practice Address - Phone:323-938-2626
Practice Address - Fax:323-938-2493
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51530207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF85833Medicare UPIN