MEDICARE: RACQUEL DELA CRUZ DIZON-SAMSON R.N.

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	163WC0200X	Critical Care Medicine Registered Nurse	625156	CA
2	163WH0200X	Home Health Registered Nurse	625156	CA

General Provider Information

NPI Number	:	1154424190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACQUEL DELA CRUZ DIZON-SAMSON R.N.

Provider Business Mailing Address
First Line	:	229 BRIDGEWATER CIRCLE
Second Line	:
City	:	SUISUN CITY
State	:	CA
Zip	:	94585
Country	:	US
Telephone Number	:	707-427-1939
Fax Number	:	707-427-1939

Provider Business Practice Location Address
First Line	:	229 BRIDGEWATER CIRCLE
Second Line	:
City	:	SUISUN CITY
State	:	CA
Zip	:	94585
Country	:	US
Telephone Number	:	707-427-1939
Fax Number	:	707-427-1939

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	09/11/2025

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