Healthcare Provider Details

I. General information

NPI: 1316874084
Provider Name (Legal Business Name): SAMANTHA ALBASHA SAFAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 E FOOTHILL BLVD STE 103
UPLAND CA
91786-4070
US

IV. Provider business mailing address

2231 CALLE MARGARITA
SAN DIMAS CA
91773-4468
US

V. Phone/Fax

Practice location:
  • Phone: 909-981-8904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95039470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: