Healthcare Provider Details

I. General information

NPI: 1538702535
Provider Name (Legal Business Name): ADRIENNE SAMS CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2452 WILSHIRE ST
RIVERSIDE CA
92501-2144
US

IV. Provider business mailing address

1498 BROOKSIDE AVE APT 111
REDLANDS CA
92373-4448
US

V. Phone/Fax

Practice location:
  • Phone: 951-682-6631
  • Fax:
Mailing address:
  • Phone: 909-406-0957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number01348166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: