Provider Demographics
NPI:1194694612
Name:SAMARA PRIMARY CARE CLINIC
Entity type:Organization
Organization Name:SAMARA PRIMARY CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUSTIN-GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-200-4489
Mailing Address - Street 1:1039 ROCK CREEK ST
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-5700
Mailing Address - Country:US
Mailing Address - Phone:321-200-4489
Mailing Address - Fax:407-554-5860
Practice Address - Street 1:2513 SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5835
Practice Address - Country:US
Practice Address - Phone:321-200-4489
Practice Address - Fax:407-554-5860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-03
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty