Healthcare Provider Details

I. General information

NPI: 1497320808
Provider Name (Legal Business Name): SIBA SAMAAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37950 47TH ST E
PALMDALE CA
93552-3271
US

IV. Provider business mailing address

37950 47TH ST E
PALMDALE CA
93552-3271
US

V. Phone/Fax

Practice location:
  • Phone: 661-285-9473
  • Fax: 661-285-5040
Mailing address:
  • Phone: 661-285-9473
  • Fax: 661-285-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number84361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: