Provider Demographics
NPI:1386606754
Name:GOOD SAMARITAN MEDICAL PRACTICE ASSOCIATION
Entity type:Organization
Organization Name:GOOD SAMARITAN MEDICAL PRACTICE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NUPUR
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:562-602-1563
Mailing Address - Street 1:10833 VALLEY VIEW ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630
Mailing Address - Country:US
Mailing Address - Phone:562-602-1563
Mailing Address - Fax:562-220-1016
Practice Address - Street 1:10833 VALLEY VIEW ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630
Practice Address - Country:US
Practice Address - Phone:562-602-1563
Practice Address - Fax:562-220-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1335521302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization