Healthcare Provider Details

I. General information

NPI: 1528984424
Provider Name (Legal Business Name): SAMANTHA THOMAS NP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 WILSHIRE BLVD STE 900
LOS ANGELES CA
90017-2905
US

IV. Provider business mailing address

611 WILSHIRE BLVD STE 900 #2017
LOS ANGELES CA
90017
US

V. Phone/Fax

Practice location:
  • Phone: 909-328-6410
  • Fax: 909-265-9425
Mailing address:
  • Phone: 909-328-6410
  • Fax: 909-265-9425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA THOMAS
Title or Position: OWNER
Credential: NP
Phone: 909-328-6410