Provider Demographics
NPI:1578751137
Name:BOSTIC, SAMANTA M
Entity Type:Individual
Prefix:
First Name:SAMANTA
Middle Name:M
Last Name:BOSTIC
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 1:5880 W LAS POSITAS BLVD STE 31
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8552
Mailing Address - Country:US
Mailing Address - Phone:925-734-0344
Mailing Address - Fax:
Practice Address - Street 1:5880 W LAS POSITAS BLVD STE 31
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8552
Practice Address - Country:US
Practice Address - Phone:925-734-0344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter