Healthcare Provider Details

I. General information

NPI: 1013577485
Provider Name (Legal Business Name): ELIZEBA SAMOEI LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 TREEMONT PL APT 102
CORONA CA
92879-7956
US

IV. Provider business mailing address

2280 TREEMONT PL APT 102
CORONA CA
92879-7956
US

V. Phone/Fax

Practice location:
  • Phone: 945-266-5010
  • Fax:
Mailing address:
  • Phone: 945-266-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number730807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: