black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

ETHAN WALLACK SAMUELS

PRODUCER NON-RESIDENT

License Number:
PRN268648
Status:
First Licensure:
05/20/2016
Cancel Date:
None

Mailing:
MALIBU, CA 90265
Phone:
+1 (310) 405-0835
Fax:
+1 (310) 295-1921
Email:
licensing.ca@neilsonfs.com

History

License Type Start Date End Date
PRODUCER NON-RESIDENT 05/20/2016

Agency

Name Issue Date License Number Expiration Date Cancel Date
NFS INSURANCE AGENCY LLC
05/20/2016 AGN263307 05/30/2019

Employer

Name Issue Date License Number Expiration Date Cancel Date
BERKSHIRE LIFE INSURANCE COMPANY OF AMERICA
02/19/2021 LHF804
FIDELITY SECURITY LIFE INSURANCE COMPANY
06/01/2016 LHF972 08/24/2017
GUARDIAN INSURANCE & ANNUITY COMPANY INC
02/19/2021 LHF27827
GUARDIAN LIFE INSURANCE COMPANY OF AMERICA
02/19/2021 LHF644

Authority

Description Issue Date Termination Date Status
LIFE 05/20/2016 Active

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
17448680

Other Addresses

Address Type
515 S FLOWER ST FL 33
LOS ANGELES, CA 90071-2246
Office

An active license/permit may still be subject to limitations and restrictions as a result of disciplinary action imposed. Please contact the specific licensing board about specific disciplinary actions.

Date: 05/19/2025 12:23:18 PM