Provider Demographics
NPI:1619636586
Name:LUTZA, SAMANTHA RACHEL (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RACHEL
Last Name:LUTZA
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:RACHEL
Other - Last Name:LUTZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:28245 AVENUE CROCKER STE 220
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1201
Mailing Address - Country:US
Mailing Address - Phone:661-254-7086
Mailing Address - Fax:
Practice Address - Street 1:28245 AVENUE CROCKER STE 220
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1201
Practice Address - Country:US
Practice Address - Phone:661-254-7086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-553392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer