Healthcare Provider Details

I. General information

NPI: 1487566857
Provider Name (Legal Business Name): SAMANTHA HYLES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 CHRISTINE DR
VACAVILLE CA
95687-4163
US

IV. Provider business mailing address

401 NUT TREE RD
VACAVILLE CA
95687-3508
US

V. Phone/Fax

Practice location:
  • Phone: 707-453-6155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: