Provider Demographics
NPI:1689387045
Name:SAMSON, SAMUEL DE CHAVEZ (NP)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DE CHAVEZ
Last Name:SAMSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 CLARINBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7210
Mailing Address - Country:US
Mailing Address - Phone:650-452-3438
Mailing Address - Fax:
Practice Address - Street 1:5763 STEVENSON BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5301
Practice Address - Country:US
Practice Address - Phone:510-656-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023358363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily