Provider Demographics
NPI:1467328237
Name:SWIERKOCKI, SAMARA MANDI
Entity type:Individual
Prefix:
First Name:SAMARA
Middle Name:MANDI
Last Name:SWIERKOCKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 EASTMAN AVE UNIT 103
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6441
Mailing Address - Country:US
Mailing Address - Phone:805-650-6290
Mailing Address - Fax:805-650-6912
Practice Address - Street 1:1601 EASTMAN AVE UNIT 103
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6441
Practice Address - Country:US
Practice Address - Phone:805-650-6290
Practice Address - Fax:805-650-6912
Is Sole Proprietor?:No
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4019225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics