Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Momona Woldemicael Samuel

Individual provider Family Nurse Practitioner · NPI 1124793419

Momona Woldemicael Samuel is a Nurse Practitioner in Los Angeles, California. Qualified in 2020, 6 years ago. Practices with St John's Community Health, a 148-clinician group and accepts Medicare assignment. Licensed in California and Washington.

Years since qualifying
6
Licensed in
CA, WA
In the registry since
2021
Specialties on file
2
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Practice location Address checks out

808 W 58th St
Los Angeles, CA 90037-3632
Phone: (323) 541-1600
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 95018215 (CA)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence AP61155406 (WA)

Record details

NPI number1124793419
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedAugust 10, 2021
Last updated in NPPESAugust 31, 2021
Certification dateAugust 31, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice St. John'S Community Health — 148 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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