Provider Demographics
NPI:1437822434
Name:FERRARA, SAMANTHA LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEE
Last Name:FERRARA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7339 EL CAJON BLVD STE I
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7435
Mailing Address - Country:US
Mailing Address - Phone:619-698-0606
Mailing Address - Fax:619-698-0609
Practice Address - Street 1:7339 EL CAJON BLVD STE I
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7435
Practice Address - Country:US
Practice Address - Phone:619-698-0606
Practice Address - Fax:619-698-0609
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant