Healthcare Provider Details

I. General information

NPI: 1376718353
Provider Name (Legal Business Name): SAMANTHA SANGANA L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E COLORADO BLVD STE 100
PASADENA CA
91107-6622
US

IV. Provider business mailing address

2555 E COLORADO BLVD STE 100
PASADENA CA
91107-6622
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-2261
  • Fax: 626-577-2543
Mailing address:
  • Phone: 626-577-2261
  • Fax: 626-577-2543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 22056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: