Healthcare Provider Details

I. General information

NPI: 1124547278
Provider Name (Legal Business Name): SAMANTHA KEIKO KOBARA M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2017
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 W REDLANDS BLVD
REDLANDS CA
92373-4641
US

IV. Provider business mailing address

11635 CIELO LN
LOMA LINDA CA
92354-3708
US

V. Phone/Fax

Practice location:
  • Phone: 909-783-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number32884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: