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NPI Code Detail

MEDICARE: SAM XAVANNA CASE MANAGER

MEDICARE: SAM XAVANNA CASE MANAGER
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
1171M00000XCase Manager/Care CoordinatorCA
2172V00000XCommunity Health Worker
3225400000XRehabilitation Practitioner
4373H00000XDay Training/Habilitation SpecialistCA

General Provider Information

NPI Number : 1184962151
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAM XAVANNA CASE MANAGER
Provider Business Mailing Address
First Line : 1635 W MAIN ST
Second Line :
City : ALHAMBRA
State : CA
Zip : 91801-1951
Country : US
Telephone Number : 626-248-1800
Fax Number :
Provider Business Practice Location Address
First Line : 1635 W MAIN ST
Second Line :
City : ALHAMBRA
State : CA
Zip : 91801-1951
Country : US
Telephone Number : 626-248-1800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2013
Last Update Date : 05/05/2025

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