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NPI Code Detail

MEDICARE: MR. RICHARD GABRIEL SAMEDRA PMHNP-BC

MEDICARE: MR. RICHARD GABRIEL SAMEDRA PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner95030301CA

General Provider Information

NPI Number : 1093561904
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICHARD GABRIEL SAMEDRA PMHNP-BC
Provider Business Mailing Address
First Line : 123 ORANGE GROVE AVE
Second Line :
City : PLACENTIA
State : CA
Zip : 92870-4848
Country : US
Telephone Number : 949-566-4308
Fax Number : 714-683-1473
Provider Business Practice Location Address
First Line : 1720 W BALL RD STE 4C
Second Line :
City : ANAHEIM
State : CA
Zip : 92804-5591
Country : US
Telephone Number : 714-683-1472
Fax Number : 714-683-1473
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2024
Last Update Date : 04/17/2025

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