Healthcare Provider Details

I. General information

NPI: 1740107994
Provider Name (Legal Business Name): SAMANTHA SLOAN WAID RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 N BRENT ST
VENTURA CA
93003-2854
US

IV. Provider business mailing address

2977 SEXTON CANYON RD
VENTURA CA
93003-1139
US

V. Phone/Fax

Practice location:
  • Phone: 805-948-5011
  • Fax:
Mailing address:
  • Phone: 805-312-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-323032
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95250005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: