Healthcare Provider Details

I. General information

NPI: 1902595069
Provider Name (Legal Business Name): JOUMANA SAMAHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

114 CHESTNUT AVE # 4
JAMAICA PLAIN MA
02130-2179
US

V. Phone/Fax

Practice location:
  • Phone: 424-306-5600
  • Fax:
Mailing address:
  • Phone: 857-231-6559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: