Healthcare Provider Details

I. General information

NPI: 1184275364
Provider Name (Legal Business Name): SAMANTHA COELHO M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28102 N LAKE WOHLFORD RD
VALLEY CENTER CA
92082-6740
US

IV. Provider business mailing address

28102 N LAKE WOHLFORD RD
VALLEY CENTER CA
92082-6740
US

V. Phone/Fax

Practice location:
  • Phone: 760-751-4295
  • Fax:
Mailing address:
  • Phone: 760-751-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number37086
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: