Provider Demographics
NPI:1285923409
Name:GOOD SAMARITAN MEDICAL CLINIC
Entity type:Organization
Organization Name:GOOD SAMARITAN MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUSSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:BESHAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-774-7500
Mailing Address - Street 1:2912 SOUTH PHOENIX PL
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-1810
Practice Address - Country:US
Practice Address - Phone:714-774-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21218261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care