Healthcare Provider Details

I. General information

NPI: 1184246746
Provider Name (Legal Business Name): SAMANTHA PARAGONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2020
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 WILSHIRE BLVD
BEVERLY HILLS CA
90211-2425
US

IV. Provider business mailing address

213 PASEO DE SUENOS
REDONDO BEACH CA
90277-6560
US

V. Phone/Fax

Practice location:
  • Phone: 310-855-2229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95028606
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN2317178
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: