Provider Demographics
NPI:1326449893
Name:OLIVEIRA, SAMANTHA (PA-C, MS, MPH)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:OLIVEIRA
Suffix:
Gender:F
Credentials:PA-C, MS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 N SAN MATEO DR
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2889
Mailing Address - Country:US
Mailing Address - Phone:650-342-0849
Mailing Address - Fax:
Practice Address - Street 1:77 N SAN MATEO DR
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2889
Practice Address - Country:US
Practice Address - Phone:650-342-0849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51921363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY740773YMedicare UPIN