| Organization Name: | SAMANTHA LLC |
| NPI Number: | 1063575892 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY JANE SUNGA CASTRO (PHYSICIAN MEMBER) |
| Mailing Address: | 75-5995 Kuakini Hwy Suite 445 Kailua Kona |
| State: | HI US |
| Postal Code: | 967402144 |
| Phone Number: | 8083262873 |
| Fax Number: | 8083269530 |
| NPI Enumeration Date: | 12/19/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 11969 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | HI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |