Active NPI
Samara Vachss Serotkin, M.S.
- Student in an Organized Health Care Education/Training Program
- Concord, CA
National Provider Identifier
1386809622
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 1333 Willow Pass Rd
Suite 102
Concord, CA 94520-7930 - Phone
- (925) 825-1793
- NPI assigned
- Jul 25, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
1333 Willow Pass Rd
Suite 102
Concord, CA 94520-7930
Mailing address
1333 Willow Pass Rd
Suite 102
Concord, CA 94520-7930
Phone (925) 825-1793
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 18, 2025 through Feb 18, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219622400000",
"number": "1386809622",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1333 WILLOW PASS RD",
"address_2": "SUITE 102",
"city": "CONCORD",
"state": "CA",
"postal_code": "945207930",
"telephone_number": "925-825-1793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1333 WILLOW PASS RD",
"address_2": "SUITE 102",
"city": "CONCORD",
"state": "CA",
"postal_code": "945207930",
"telephone_number": "925-825-1793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEROTKIN",
"first_name": "SAMARA",
"middle_name": "VACHSS",
"name_prefix": "Mrs.",
"credential": "M.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-25",
"last_updated": "2008-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.