Healthcare Provider Details

I. General information

NPI: 1629987276
Provider Name (Legal Business Name): SAMANTHA LAURETA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10431 COMMERCE ST STE A
REDLANDS CA
92374-0110
US

IV. Provider business mailing address

15665 LANYARD LN
CHINO HILLS CA
91709-8707
US

V. Phone/Fax

Practice location:
  • Phone: 909-735-7654
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number29400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: