Healthcare Provider Details

I. General information

NPI: 1962315531
Provider Name (Legal Business Name): SAMANTHA JAENNETTE RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 AMERICAN OAKS AVE
NEWBURY PARK CA
91320-5102
US

IV. Provider business mailing address

543 AMERICAN OAKS AVE
NEWBURY PARK CA
91320-5102
US

V. Phone/Fax

Practice location:
  • Phone: 805-558-8158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number40972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: