Healthcare Provider Details

I. General information

NPI: 1669041752
Provider Name (Legal Business Name): MICHAEL SAMORA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4152 W SWIFT AVE STE 104
FRESNO CA
93722-6388
US

IV. Provider business mailing address

5132 N PALM AVE # 303
FRESNO CA
93704-2236
US

V. Phone/Fax

Practice location:
  • Phone: 559-492-7900
  • Fax:
Mailing address:
  • Phone: 559-492-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-262836709
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: