Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | A99671 | CA |
N | 208000000X | Pediatrician | A99671 | CA |
NPI | 1164683678 |
---|---|
Provider Name | Yana Samarasena |
First Address | Fountain Valley, CA 92708-7506 |
Second Address | Fountain Valley, CA 92708-7506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2008 |
Last Update Date | 06/12/2021 |