Provider Demographics
NPI:1043381254
Name:SAMSON, MARIA LOURDES ORETA (NP)
Entity Type:Individual
Prefix:
First Name:MARIA LOURDES
Middle Name:ORETA
Last Name:SAMSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14427 CHASE ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-3020
Mailing Address - Country:US
Mailing Address - Phone:818-830-7751
Mailing Address - Fax:818-891-7892
Practice Address - Street 1:14427 CHASE ST
Practice Address - Street 2:STE. 100
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-3020
Practice Address - Country:US
Practice Address - Phone:818-830-7751
Practice Address - Fax:818-891-7892
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16657163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice