Healthcare Provider Details

I. General information

NPI: 1295435683
Provider Name (Legal Business Name): SAMANTHA MALAGON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2736 HOLLYWOOD BLVD
HOLLYWOOD FL
33020-4808
US

IV. Provider business mailing address

2736 HOLLYWOOD BLVD
HOLLYWOOD FL
33020-4808
US

V. Phone/Fax

Practice location:
  • Phone: 954-603-1881
  • Fax: 954-603-5341
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI6024
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: