1740232727 NPI number — MICHAEL SAMKO, PH.D., INC.

Table of content: (NPI 1740232727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740232727 NPI number — MICHAEL SAMKO, PH.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL SAMKO, PH.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740232727
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2181 S EL CAMINO REAL
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92054-6220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-721-1111
Provider Business Mailing Address Fax Number:
760-721-1116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2181 S EL CAMINO REAL
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92054-6220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-721-1111
Provider Business Practice Location Address Fax Number:
760-721-1116
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAMKO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
760-721-1111

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY5420 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00203711 . This is a "RAILROAD MEDICARE ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00PL54200 . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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