Provider Demographics
NPI:1316084312
Name:SOM, SAM (FNP-C)
Entity type:Individual
Prefix:MR
First Name:SAM
Middle Name:
Last Name:SOM
Suffix:
Gender:M
Credentials:FNP-C
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Other - First Name:
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Mailing Address - Street 1:17330 BEAR VALLEY RD
Mailing Address - Street 2:SUITE A 106
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7741
Mailing Address - Country:US
Mailing Address - Phone:760-245-9999
Mailing Address - Fax:760-245-8855
Practice Address - Street 1:17330 BEAR VALLEY RD
Practice Address - Street 2:SUITE A 106
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7741
Practice Address - Country:US
Practice Address - Phone:760-245-9999
Practice Address - Fax:760-245-8855
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2014-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA559654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily