Provider Demographics
NPI:1457840035
Name:JOHNSON, SAMANTHA SCHNEIDER (DO)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SCHNEIDER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:SCHNEIDER JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1124 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-4449
Mailing Address - Country:US
Mailing Address - Phone:951-737-6363
Mailing Address - Fax:
Practice Address - Street 1:1124 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-4449
Practice Address - Country:US
Practice Address - Phone:951-737-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA19662207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program