Provider Demographics
NPI:1811067291
Name:SAMSON, RICARDO A (MD)
Entity type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:A
Last Name:SAMSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3131 LA CANADA ST STE 230
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2551
Mailing Address - Country:US
Mailing Address - Phone:702-732-1290
Mailing Address - Fax:702-732-1385
Practice Address - Street 1:3131 LA CANADA ST STE 230
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2551
Practice Address - Country:US
Practice Address - Phone:702-732-1290
Practice Address - Fax:702-732-1385
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ224802080P0202X
NV163952080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ175390Medicaid
AZ175390Medicaid
F10170Medicare UPIN