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SAM MAVIS
NPI 1043738370
Student in an Organized Health Care Education/Training Program in Pacoima, CA

Active since September 07, 2017PECOS Enrolled
12450 VAN NUYS BLVD, PACOIMA, CA 91331(818) 896-1161(818) 896-5069 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Sam Mavis NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAM MAVIS (NPI 1043738370) is an individual student in an organized health care education/training program in Pacoima, California and active in the NPI registry since September 2017. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1043738370
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameSAM MAVIS
Location Address12450 VAN NUYS BLVDPacoima, CA 91331-1391
Mailing Address12450 Van Nuys BlvdPacoima, CA 91331-1391 · (818) 896-1161 · Fax (818) 896-5069
Phone(818) 896-1161
Fax(818) 896-5069
Sole ProprietorNo
Enumeration DateSeptember 7, 2017
Last NPPES UpdateJuly 21, 2022
✔ NPI 1043738370 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
12450 VAN NUYS BLVD, Pacoima, CA 91331
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Other Identifiers 3

Medicaid6758CA
Medicaid7420CA
Medicaid7068CA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Sam Mavis is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CESAR FRANCO
Case Manager/Care Coordinator
12450 VAN NUYS BLVD, SUITE 200
PACOIMA, CA 91331
Los Angeles County (818) 896-1161
MRS. SUE NOVACK SORENSEN LCSW
Social Worker (Clinical)
12450 VAN NUYS BLVD, 100
PACOIMA, CA 91331
Los Angeles County (818) 896-8366
VALENTINA USUBYAN
Counselor (Mental Health)
12450 VAN NUYS BLVD
PACOIMA, CA 91331
Los Angeles County (818) 896-1161
MARIA DIAZ
Peer Specialist
12450 VAN NUYS BLVD, 200
PACOIMA, CA 91331
Los Angeles County (818) 896-1161
MR. VERNON WOLF WINDELL MFT
Marriage & Family Therapist
12450 VAN NUYS BLVD, SUITE 200
PACOIMA, CA 91331
Los Angeles County (818) 896-1161
ELENA KARENEV
Counselor (Mental Health)
12450 VAN NUYS BLVD, SUITE 200
PACOIMA, CA 91331
Los Angeles County (818) 896-1161
ELANI TUCHMAN M.A.
Psychologist (Clinical)
12450 VAN NUYS BLVD, SUITE 200
PACOIMA, CA 91331
Los Angeles County (818) 896-1161
DR. MELISSA DIANE BOUDIN PSY.D.
Psychologist (Clinical)
12450 VAN NUYS BLVD, SUITE 200
PACOIMA, CA 91331
Los Angeles County (818) 896-1161

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sam Mavis's NPI number?

The NPI number for Sam Mavis is 1043738370. It was assigned to this individual provider in the NPPES registry on September 7, 2017.

Where is Sam Mavis located?

Sam Mavis practices at 12450 Van Nuys Blvd, Pacoima, CA 91331. The listed phone number is (818) 896-1161.

What is Sam Mavis's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Sam Mavis enrolled in Medicare?

Yes. Sam Mavis is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Sam Mavis was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.