Healthcare Provider Details

I. General information

NPI: 1265345722
Provider Name (Legal Business Name): SAMANTHA SYLVIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 CA-1 STE 319
HERMOSA BEACH CA
90254
US

IV. Provider business mailing address

7813 ALVERSTONE AVE
LOS ANGELES CA
90045-1422
US

V. Phone/Fax

Practice location:
  • Phone: 310-974-0533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: