Healthcare Provider Details

I. General information

NPI: 1144968041
Provider Name (Legal Business Name): SAMANTHA FLORES MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2022
Last Update Date: 05/22/2022
Certification Date: 05/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 PARKWAY DR
LA MESA CA
91942-1535
US

IV. Provider business mailing address

4440 BOUNDARY ST APT 6
SAN DIEGO CA
92116-4303
US

V. Phone/Fax

Practice location:
  • Phone: 619-667-6050
  • Fax:
Mailing address:
  • Phone: 818-399-8703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: