Provider Demographics
NPI:1528126547
Name:SAMPSON, STEVEN ELLIOTT (DO)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ELLIOTT
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:10780 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4749
Mailing Address - Country:US
Mailing Address - Phone:310-453-5404
Mailing Address - Fax:310-453-2535
Practice Address - Street 1:10780 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 440
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4749
Practice Address - Country:US
Practice Address - Phone:310-453-5404
Practice Address - Fax:310-453-2535
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9589208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAP237Medicare UPIN
W20A9589AMedicare PIN