Provider Demographics
NPI:1639930852
Name:MAYO, SAMANTHA E (RN, BSN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:E
Last Name:MAYO
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 MISSION CENTER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1347
Mailing Address - Country:US
Mailing Address - Phone:619-997-4510
Mailing Address - Fax:619-984-5440
Practice Address - Street 1:5333 MISSION CENTER RD STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1347
Practice Address - Country:US
Practice Address - Phone:619-997-4510
Practice Address - Fax:619-984-5440
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95332632163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse