Healthcare Provider Details

I. General information

NPI: 1376467555
Provider Name (Legal Business Name): SAMANTHA AUBREY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26520 CACTUS AVE
MORENO VALLEY CA
92555-3927
US

IV. Provider business mailing address

13351 DAFFODIL LN
YUCAIPA CA
92399-5150
US

V. Phone/Fax

Practice location:
  • Phone: 951-486-5650
  • Fax:
Mailing address:
  • Phone: 909-848-0455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95032839
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95255454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: