Provider Demographics
NPI:1437916012
Name:SAMARRIPA, ADRIAN ELI
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:ELI
Last Name:SAMARRIPA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1482 S 42ND DR
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4034
Mailing Address - Country:US
Mailing Address - Phone:562-668-6136
Mailing Address - Fax:
Practice Address - Street 1:650 S COUNTRY CLUB DR APT 222
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2345
Practice Address - Country:US
Practice Address - Phone:562-668-6136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer