MEDICARE: DEBRA SAMUELS

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	235Z00000X	Speech-Language Pathologist	13667	CA

General Provider Information

NPI Number	:	1851749626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA SAMUELS

Provider Business Mailing Address
First Line	:	1110 HACIENDA PL APT 403
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-2767
Country	:	US
Telephone Number	:	310-850-3978
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 HACIENDA PL APT 403
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-2767
Country	:	US
Telephone Number	:	310-850-3978
Fax Number	:

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

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	06/01/2016

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Directions to “ DEBRA SAMUELS ” Practice Location

Language	Start Address	Practice Location

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