Healthcare Provider Details

I. General information

NPI: 1669264289
Provider Name (Legal Business Name): MAYA HAISAM SAMAAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 E SANTA CLARA ST STE 101A
VENTURA CA
93001-2965
US

IV. Provider business mailing address

701 PERTH PL
OXNARD CA
93035-1220
US

V. Phone/Fax

Practice location:
  • Phone: 805-290-9986
  • Fax:
Mailing address:
  • Phone: 805-816-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: