Individual
ELDEN ISAAC LOPEZ SAMAYOA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4719 W MARGARET ST, PASCO, WA 99301-2822
(909) 486-3206
Mailing address
4719 W MARGARET ST, PASCO, WA 99301-2822
(909) 486-3206
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
A49982
CA
208000000X
Pediatrics Physician
Primary
MD00027394
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1059633
—
WA
Enumeration date
12/27/2005
Last updated
12/08/2015
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