Healthcare Provider Details

I. General information

NPI: 1932590775
Provider Name (Legal Business Name): SAMAH SHAHZYA KURESHI WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 VANDERBILT LN UNIT B
REDONDO BEACH CA
90278-3318
US

IV. Provider business mailing address

2619 VANDERBILT LN UNIT B
REDONDO BEACH CA
90278-3318
US

V. Phone/Fax

Practice location:
  • Phone: 310-625-5554
  • Fax:
Mailing address:
  • Phone: 310-625-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number95001071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: