Provider Demographics
NPI:1366982688
Name:MROUE, SAMAR
Entity type:Individual
Prefix:
First Name:SAMAR
Middle Name:
Last Name:MROUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 CALLE VALLE VIS
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1939
Mailing Address - Country:US
Mailing Address - Phone:805-390-3943
Mailing Address - Fax:805-309-2376
Practice Address - Street 1:3322 ARIOUS WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-8419
Practice Address - Country:US
Practice Address - Phone:661-886-8852
Practice Address - Fax:661-206-8655
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70279163WP0200X
CA233953163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WP0200XNursing Service ProvidersRegistered NursePediatrics