Provider Demographics
NPI:1790322253
Name:SAMIMI, RETA (PA-C)
Entity type:Individual
Prefix:
First Name:RETA
Middle Name:
Last Name:SAMIMI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1133 E STANLEY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4270
Mailing Address - Country:US
Mailing Address - Phone:925-454-4280
Mailing Address - Fax:925-454-4284
Practice Address - Street 1:1133 E STANLEY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4270
Practice Address - Country:US
Practice Address - Phone:925-454-4280
Practice Address - Fax:925-454-4284
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
CA57980363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant