MEDICARE: SAMANTHA SANTOSA PA-C

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	363A00000X	Physician Assistant	PA67505	CA

General Provider Information

NPI Number	:	1720942097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA SANTOSA PA-C

Provider Business Mailing Address
First Line	:	8432 MAGNOLIA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-3206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8432 MAGNOLIA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-3206
Country	:	US
Telephone Number	:	951-552-8593
Fax Number	:

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

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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