Provider Demographics
NPI:1316915226
Name:SAMAAN, FAWZIA F (MD)
Entity type:Individual
Prefix:DR
First Name:FAWZIA
Middle Name:F
Last Name:SAMAAN
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 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:800-883-7243
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:1050 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3321
Practice Address - Country:US
Practice Address - Phone:800-883-7243
Practice Address - Fax:714-647-1245
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45376207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A453762Medicaid
CAAW916Medicare PIN
CAA45376Medicare PIN
CAAW916XMedicare PIN
CACB211895Medicare PIN
CAAW916WMedicare PIN
CAE62080Medicare UPIN
CA00A453762Medicaid
CAAW916VMedicare PIN