Healthcare Provider Details

I. General information

NPI: 1437980117
Provider Name (Legal Business Name): ELIZA SAMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

679 S NEW HAMPSHIRE AVE FL 4
LOS ANGELES CA
90005-1355
US

IV. Provider business mailing address

2807 ST GEORGE ST
LOS ANGELES CA
90027-3016
US

V. Phone/Fax

Practice location:
  • Phone: 213-639-2500
  • Fax:
Mailing address:
  • Phone: 801-664-7628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW138825
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: