Provider Demographics
NPI:1093935116
Name:SAMUEL, DEE ANN MAUDE (LVN)
Entity Type:Individual
Prefix:MS
First Name:DEE ANN
Middle Name:MAUDE
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 W 67TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-1721
Mailing Address - Country:US
Mailing Address - Phone:323-286-6249
Mailing Address - Fax:
Practice Address - Street 1:3130 S HILL ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3817
Practice Address - Country:US
Practice Address - Phone:213-747-7267
Practice Address - Fax:213-747-4835
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA178319101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)