MEDICARE: ELIZA SAMORE

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
2	104100000X	Social Worker	ASW138825	CA

General Provider Information

NPI Number	:	1437980117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZA SAMORE

Provider Business Mailing Address
First Line	:	2807 ST GEORGE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-3016
Country	:	US
Telephone Number	:	801-664-7628
Fax Number	:

Provider Business Practice Location Address
First Line	:	679 S NEW HAMPSHIRE AVE FL 4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1355
Country	:	US
Telephone Number	:	213-639-2500
Fax Number	:

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

Provider Enumeration Date	:	08/13/2024
Last Update Date	:	06/11/2026

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Directions to “ ELIZA SAMORE ” Practice Location

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