Healthcare Provider Details

I. General information

NPI: 1366142655
Provider Name (Legal Business Name): SAMANTHA LOUIS HABECK LE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER ST RM 1010
SAN FRANCISCO CA
94108-3912
US

IV. Provider business mailing address

450 SUTTER ST RM 1010
SAN FRANCISCO CA
94108-3912
US

V. Phone/Fax

Practice location:
  • Phone: 415-780-1515
  • Fax: 415-398-7784
Mailing address:
  • Phone: 415-780-1515
  • Fax: 415-398-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License NumberRN743292
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL9780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: