Healthcare Provider Details

I. General information

NPI: 1881452548
Provider Name (Legal Business Name): CHRISTINE SAMUEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W COAST HWY STE 500
NEWPORT BEACH CA
92663-4043
US

IV. Provider business mailing address

23642 SIDNEY BAY
DANA POINT CA
92629-4208
US

V. Phone/Fax

Practice location:
  • Phone: 949-646-0077
  • Fax:
Mailing address:
  • Phone: 917-836-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAG02240125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: