Provider Demographics
NPI:1083127260
Name:PEARSON, SAMANTHA J
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:PEARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 S PADRE ISLAND DR APT C04
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-5226
Mailing Address - Country:US
Mailing Address - Phone:210-913-4783
Mailing Address - Fax:
Practice Address - Street 1:6300 OCEAN DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-5503
Practice Address - Country:US
Practice Address - Phone:361-825-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program