Healthcare Provider Details

I. General information

NPI: 1922992262
Provider Name (Legal Business Name): AZSHA MARIE SAMANDO FNP-C/BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 W MAIN ST UNIT 583
RIPON CA
95366-1523
US

IV. Provider business mailing address

1275 W MAIN ST UNIT 583
RIPON CA
95366-1523
US

V. Phone/Fax

Practice location:
  • Phone: 209-735-5000
  • Fax:
Mailing address:
  • Phone: 209-735-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95026021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: