Provider Demographics
NPI:1427537356
Name:SANCHEZ, SAMANTHA AURORA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:AURORA
Last Name:SANCHEZ
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 1:22115 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3899
Mailing Address - Country:US
Mailing Address - Phone:818-884-8100
Mailing Address - Fax:818-884-7808
Practice Address - Street 1:22115 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-3899
Practice Address - Country:US
Practice Address - Phone:818-884-8100
Practice Address - Fax:818-884-7808
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7283Medicaid