Provider Demographics
NPI:1073630281
Name:SAMALA, VERONICA RODRIGUEZ (MD)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:RODRIGUEZ
Last Name:SAMALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 E SLAUSON AVE STE G
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-2889
Mailing Address - Country:US
Mailing Address - Phone:323-581-0791
Mailing Address - Fax:323-581-2161
Practice Address - Street 1:2550 E SLAUSON AVE STE G
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2889
Practice Address - Country:US
Practice Address - Phone:323-581-0791
Practice Address - Fax:323-581-2161
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37573174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA37573OtherMEDICAL BOARD