Healthcare Provider Details

I. General information

NPI: 1972213742
Provider Name (Legal Business Name): CHRISTINA SAMANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 E FOOTHILL BLVD
PASADENA CA
91107-3439
US

IV. Provider business mailing address

113 N GRAND OAKS AVE APT 8
PASADENA CA
91107-3619
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-2261
  • Fax:
Mailing address:
  • Phone: 916-903-8459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: