Healthcare Provider Details

I. General information

NPI: 1710502315
Provider Name (Legal Business Name): SAMANTHA LEIGH GAETANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD BLDG A2
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

4333 N 6TH DR APT 235
PHOENIX AZ
85013-3193
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-3949
  • Fax:
Mailing address:
  • Phone: 201-595-9990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMT221518
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberR80700
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number74471
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: