Healthcare Provider Details

I. General information

NPI: 1396536744
Provider Name (Legal Business Name): SAMA MARAQA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10418 CARDERA DR
RIVERVIEW FL
33578-4073
US

IV. Provider business mailing address

10418 CARDERA DR
RIVERVIEW FL
33578-4073
US

V. Phone/Fax

Practice location:
  • Phone: 813-312-4599
  • Fax:
Mailing address:
  • Phone: 813-312-4599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN30576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: