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General NPI Number Information
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NPI Number | 1558255471
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Entity Type | Individual
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Provider Name | SAMANTHA IRISH CPED
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Gender | Female
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 8050 E GERMANN RD
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City | MESA
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State | AZ
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Zip | 85212
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Country | US
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Telephone | 520-990-5728
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Fax |
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Provider Business Mailing Address
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Address Line | 10563 E CAROLINA WILLOW LN
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City | TUCSON
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State | AZ
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Zip | 85747-9538
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Country | US
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Telephone | 520-990-5728
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224L00000X
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Taxonomy Name | Pedorthist
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License Number | CPED4668
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License Number State | AZ
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