Provider Demographics
NPI:1104930296
Name:SAMUELSON, ALBERTA WOODWORTH (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERTA
Middle Name:WOODWORTH
Last Name:SAMUELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3640 LOMITA BLVD
Mailing Address - Street 2:#209
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3981
Mailing Address - Country:US
Mailing Address - Phone:310-373-3233
Mailing Address - Fax:310-375-8845
Practice Address - Street 1:3640 LOMITA BLVD
Practice Address - Street 2:#209
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3981
Practice Address - Country:US
Practice Address - Phone:310-373-3233
Practice Address - Fax:310-375-8845
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA192462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A82032Medicare ID - Type Unspecified