Provider Demographics
NPI:1285123083
Name:SAMUELU, TEEVALE ESSIE
Entity type:Individual
Prefix:MS
First Name:TEEVALE
Middle Name:ESSIE
Last Name:SAMUELU
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TEEVALE
Other - Middle Name:ESSIE
Other - Last Name:PATI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2748 FASHION AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90810-3141
Mailing Address - Country:US
Mailing Address - Phone:562-235-1004
Mailing Address - Fax:
Practice Address - Street 1:12440 FIRESTONE BLVD STE 3020
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-9328
Practice Address - Country:US
Practice Address - Phone:562-864-7821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN241848164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse