Provider Demographics
NPI:1932311727
Name:SAMAC, DIANA LOUISE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LOUISE
Last Name:SAMAC
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402
Mailing Address - Country:US
Mailing Address - Phone:805-528-1902
Mailing Address - Fax:
Practice Address - Street 1:1106 PACIFIC STREET
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:805-546-9500
Practice Address - Fax:805-546-9699
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA695142163W00000X
CA17173363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
A0407061OtherAANP ANP CERTIFICATION