Healthcare Provider Details

I. General information

NPI: 1396425484
Provider Name (Legal Business Name): SAMANTHA KHAMO ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2164 E BROADWAY RD
TEMPE AZ
85282-1766
US

IV. Provider business mailing address

7023 N 84TH AVE
GLENDALE AZ
85305-6994
US

V. Phone/Fax

Practice location:
  • Phone: 480-970-0000
  • Fax: 480-970-0003
Mailing address:
  • Phone: 623-476-9922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: