Healthcare Provider Details

I. General information

NPI: 1184533150
Provider Name (Legal Business Name): SAMUEL PRICE PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7030 AMHERST CT
RANCHO CUCAMONGA CA
91701-6079
US

IV. Provider business mailing address

7030 AMHERST CT
RANCHO CUCAMONGA CA
91701-6079
US

V. Phone/Fax

Practice location:
  • Phone: 267-205-4579
  • Fax:
Mailing address:
  • Phone: 267-205-4579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95041137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: