MEDICARE: SAMANTHA RUNDLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	20A24559	CA

General Provider Information

NPI Number	:	1073353108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA RUNDLE

Provider Business Mailing Address
First Line	:	1201 ALHAMBRA BLVD STE 300
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5241
Country	:	US
Telephone Number	:	916-731-7866
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 ALHAMBRA BLVD STE 300
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5241
Country	:	US
Telephone Number	:	916-731-7866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2024
Last Update Date	:	03/02/2026

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Directions to “ SAMANTHA RUNDLE ” Practice Location

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