Healthcare Provider Details

I. General information

NPI: 1093079089
Provider Name (Legal Business Name): SAMUEL ANTHONY LIBEU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9272 LAGUNA SPRINGS DR
ELK GROVE CA
95758-7947
US

IV. Provider business mailing address

9272 LAGUNA SPRINGS DR
ELK GROVE CA
95758-7947
US

V. Phone/Fax

Practice location:
  • Phone: 916-691-0209
  • Fax:
Mailing address:
  • Phone: 916-691-0209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberA154507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: