Healthcare Provider Details

I. General information

NPI: 1427945229
Provider Name (Legal Business Name): SAMANTHA LLANAS-MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 IMPERIAL AVE
SAN DIEGO CA
92101-7638
US

IV. Provider business mailing address

318 E 22ND ST APT 205
NATIONAL CITY CA
91950-6769
US

V. Phone/Fax

Practice location:
  • Phone: 619-645-6405
  • Fax: 619-687-1067
Mailing address:
  • Phone: 619-735-6842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: