Healthcare Provider Details

I. General information

NPI: 1316620495
Provider Name (Legal Business Name): SAMANTHA AGUAYO OREGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E CENTER AVE
VISALIA CA
93291-6331
US

IV. Provider business mailing address

2731 ORANGE AVE
CORCORAN CA
93212-9748
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone: 559-380-8647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: