Provider Demographics
NPI:1982789145
Name:SAMPSON, NATALIE RENE (DPT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:RENE
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:CLARK
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:4505 LAS VIRGENES RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1956
Mailing Address - Country:US
Mailing Address - Phone:818-880-4758
Mailing Address - Fax:818-880-4781
Practice Address - Street 1:4505 LAS VIRGENES RD STE 104
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1956
Practice Address - Country:US
Practice Address - Phone:818-880-4758
Practice Address - Fax:818-880-4781
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28547174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18705Medicare UPIN