Healthcare Provider Details

I. General information

NPI: 1962009084
Provider Name (Legal Business Name): SAMANTHA BARTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 E BASELINE RD STE 420
GILBERT AZ
85234-2472
US

IV. Provider business mailing address

1300 W WARNER RD APT 2103
GILBERT AZ
85233-7077
US

V. Phone/Fax

Practice location:
  • Phone: 480-474-4173
  • Fax: 480-422-2436
Mailing address:
  • Phone: 515-205-0179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-134810
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: