Healthcare Provider Details

I. General information

NPI: 1447010681
Provider Name (Legal Business Name): SAMANTHA HERBERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO # 74240
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

8548 TIMARU TRL
RENO NV
89523-3879
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-6000
  • Fax:
Mailing address:
  • Phone: 408-623-4790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2025-0115
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: