Provider Demographics
NPI:1114252863
Name:LAISURE-POOL, SAMANTHA KANTOR (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:KANTOR
Last Name:LAISURE-POOL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ERIN
Other - Last Name:KANTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6320 W UNION HILLS DR STE A100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1099
Mailing Address - Country:US
Mailing Address - Phone:623-233-1300
Mailing Address - Fax:623-233-1313
Practice Address - Street 1:6320 W UNION HILLS DR STE A100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1099
Practice Address - Country:US
Practice Address - Phone:623-233-1300
Practice Address - Fax:623-233-1313
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4445363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant