MEDICARE: SAMANTHA FETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1043914377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA FETT

Provider Business Mailing Address
First Line	:	6860 DE LONGPRE AVE APT 6
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7635
Country	:	US
Telephone Number	:	310-909-6711
Fax Number	:

Provider Business Practice Location Address
First Line	:	6860 DE LONGPRE AVE APT 6
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7635
Country	:	US
Telephone Number	:	310-909-6711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2023
Last Update Date	:	03/29/2023

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Directions to “ SAMANTHA FETT ” Practice Location

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