Active NPI
Samer Fawaz
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1609592864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 135019
- Practice address
- 10586 W Pico Blvd # 257
Los Angeles, CA 90064-2332 - Phone
- (310) 923-1905
- NPI assigned
- Oct 18, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 135019 | CA | Primary |
Addresses
Primary practice location
10586 W Pico Blvd # 257
Los Angeles, CA 90064-2332
Mailing address
10586 W Pico Blvd # 257
Los Angeles, CA 90064-2332
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 135019 | Other | CA | AMFT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Previously, effective Aug 27, 2024 through Aug 27, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 135019 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666051200000",
"number": "1609592864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10586 W PICO BLVD # 257",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900642332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10586 W PICO BLVD # 257",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900642332",
"telephone_number": "310-923-1905"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAWAZ",
"first_name": "SAMER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-10-18",
"last_updated": "2022-10-18",
"certification_date": "2022-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "135019",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMFT",
"identifier": "135019",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.