Provider Demographics
NPI:1275213084
Name:DULAK, SAMANTHA L (ND)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:L
Last Name:DULAK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16810 E JACKLIN DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-5443
Mailing Address - Country:US
Mailing Address - Phone:480-772-9416
Mailing Address - Fax:
Practice Address - Street 1:2164 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1766
Practice Address - Country:US
Practice Address - Phone:480-970-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath