Provider Demographics
NPI:1083301881
Name:MUJICA, SAMANTHA ELISE
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ELISE
Last Name:MUJICA
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 1:3150 N TENAYA WAY STE 480
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0494
Mailing Address - Country:US
Mailing Address - Phone:702-562-5519
Mailing Address - Fax:
Practice Address - Street 1:3150 N TENAYA WAY STE 480
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0494
Practice Address - Country:US
Practice Address - Phone:702-562-5519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program