Healthcare Provider Details

I. General information

NPI: 1811136435
Provider Name (Legal Business Name): SUSAN LEE SAMARO I BH CASE AIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 BLANCO CIR STE B
SALINAS CA
93901-4451
US

IV. Provider business mailing address

951 BLANCO CIR STE B
SALINAS CA
93901-4451
US

V. Phone/Fax

Practice location:
  • Phone: 831-784-2150
  • Fax: 831-772-8154
Mailing address:
  • Phone: 831-784-2150
  • Fax: 831-772-8154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: