Healthcare Provider Details

I. General information

NPI: 1477349363
Provider Name (Legal Business Name): SAMANTHA CAMILLE DE LA CRUZ KASINGSING NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 PINE ORCHARD ST
PACOIMA CA
91331-6907
US

IV. Provider business mailing address

9711 PINE ORCHARD ST
PACOIMA CA
91331-6907
US

V. Phone/Fax

Practice location:
  • Phone: 323-470-4278
  • Fax:
Mailing address:
  • Phone: 323-470-4278
  • Fax: 818-488-9024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03250490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: