Healthcare Provider Details

I. General information

NPI: 1053880831
Provider Name (Legal Business Name): SAMANTHA OKUMURA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 03/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E BRIDGER AVE STE 150
LAS VEGAS NV
89101
US

IV. Provider business mailing address

701 E BRIDGER AVE STE 150
LAS VEGAS NV
89101-8954
US

V. Phone/Fax

Practice location:
  • Phone: 702-308-5870
  • Fax:
Mailing address:
  • Phone: 702-308-5870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255R0406X
TaxonomyBlind Rehabilitation Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: