Individual
SAMANTHA FORMICA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
655 MARIE ANTOINETTE ST APT 416, LAFAYETTE, LA 70506-8203
(760) 613-7548
Mailing address
655 MARIE ANTOINETTE ST APT 416, LAFAYETTE, LA 70506-8203
(760) 613-7548
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
02/26/2025
Last updated
02/26/2025
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