Healthcare Provider Details

I. General information

NPI: 1992107429
Provider Name (Legal Business Name): SAMANTHA BEFIDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 W COMMERCE CT
GILBERT AZ
85233-4418
US

IV. Provider business mailing address

164 W COMMERCE CT
GILBERT AZ
85233-4418
US

V. Phone/Fax

Practice location:
  • Phone: 480-868-9735
  • Fax:
Mailing address:
  • Phone: 480-868-9735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8601
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: