Provider Demographics
NPI:1821851726
Name:ALTAVILLA, SAMANTHA (PPS)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ALTAVILLA
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:BRITTO JACOBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PPS
Mailing Address - Street 1:5101 GARDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95633-9261
Mailing Address - Country:US
Mailing Address - Phone:530-333-8330
Mailing Address - Fax:
Practice Address - Street 1:5101 GARDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GARDEN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95633-9261
Practice Address - Country:US
Practice Address - Phone:530-333-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool