Provider Demographics
NPI:1023574837
Name:SAMSON, CONETTE LAMOGLIA (AA)
Entity Type:Individual
Prefix:
First Name:CONETTE
Middle Name:LAMOGLIA
Last Name:SAMSON
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5918 WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-3131
Mailing Address - Country:US
Mailing Address - Phone:619-813-5580
Mailing Address - Fax:
Practice Address - Street 1:707 CIVIC CENTER DR STE 202
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6162
Practice Address - Country:US
Practice Address - Phone:760-294-1206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-17
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other