Provider Demographics
NPI:1922992262
Name:SAMANDO, AZSHA MARIE (FNP-C/BC)
Entity type:Individual
Prefix:MS
First Name:AZSHA
Middle Name:MARIE
Last Name:SAMANDO
Suffix:
Gender:F
Credentials:FNP-C/BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 W MAIN ST UNIT 583
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-1523
Mailing Address - Country:US
Mailing Address - Phone:209-735-5000
Mailing Address - Fax:
Practice Address - Street 1:1275 W MAIN ST UNIT 583
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:CA
Practice Address - Zip Code:95366-1523
Practice Address - Country:US
Practice Address - Phone:209-735-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026021208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice