Provider Demographics
NPI:1508638297
Name:PARRA, SAMANTHA KATHERINE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KATHERINE
Last Name:PARRA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 3900
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2436
Mailing Address - Country:US
Mailing Address - Phone:323-307-0800
Mailing Address - Fax:323-307-0800
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 3900
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2436
Practice Address - Country:US
Practice Address - Phone:323-307-0800
Practice Address - Fax:323-307-0800
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95026893363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care