Provider Demographics
NPI:1003575945
Name:ARELLANO, SAMANTHA (NONE)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ARELLANO
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 E PALMDALE BLVD STE 129
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4930
Mailing Address - Country:US
Mailing Address - Phone:661-947-3333
Mailing Address - Fax:661-575-2397
Practice Address - Street 1:2720 E PALMDALE BLVD STE 129
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4930
Practice Address - Country:US
Practice Address - Phone:661-947-3333
Practice Address - Fax:661-575-2397
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker