Provider Demographics
NPI:1629206859
Name:NOGALES, SAMANTHA LYNN CONTRERAS (O D)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:LYNN CONTRERAS
Last Name:NOGALES
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:560 E CONTINENTAL RD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-1825
Mailing Address - Country:US
Mailing Address - Phone:520-625-5673
Mailing Address - Fax:520-625-6259
Practice Address - Street 1:560 E CONTINENTAL RD UNIT 104
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-1825
Practice Address - Country:US
Practice Address - Phone:520-625-5673
Practice Address - Fax:520-625-6259
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ587162Medicaid
AZZ140117Medicare PIN