Active NPI
Elden Isaac Lopez Samayoa, MD
- Pediatrics Physician
- Pasco, WA
National Provider Identifier
1699752295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD00027394
- Practice address
- 4719 W Margaret St
Pasco, WA 99301-2822 - Phone
- (909) 486-3206
- NPI assigned
- Dec 27, 2005
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD00027394 | WA | Primary |
| Family Medicine Physician | 207Q00000X | A49982 | CA |
Addresses
Primary practice location
4719 W Margaret St
Pasco, WA 99301-2822
Mailing address
4719 W Margaret St
Pasco, WA 99301-2822
Phone (909) 486-3206
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1059633 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49982 | CA | MD | General Practice Dentistry |
| A49982 | CA | MD | Family Medicine Physician |
| MD00027394 | WA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449532800000",
"number": "1699752295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4719 W MARGARET ST",
"city": "PASCO",
"state": "WA",
"postal_code": "993012822",
"telephone_number": "909-486-3206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4719 W MARGARET ST",
"city": "PASCO",
"state": "WA",
"postal_code": "993012822",
"telephone_number": "909-486-3206"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ SAMAYOA",
"first_name": "ELDEN",
"middle_name": "ISAAC",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-27",
"last_updated": "2015-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WA",
"license": "MD00027394",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "A49982",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1059633",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pasco, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.