Provider Demographics
NPI:1275791477
Name:SAMPATH, NEHA JAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:NEHA
Middle Name:JAIN
Last Name:SAMPATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NEHA
Other - Middle Name:
Other - Last Name:JAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6354 MONTEZ VILLA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-5788
Mailing Address - Country:US
Mailing Address - Phone:858-752-4588
Mailing Address - Fax:
Practice Address - Street 1:6354 MONTEZ VILLA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-5788
Practice Address - Country:US
Practice Address - Phone:858-752-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-26
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105989207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEV501ZOtherMEDICARE PTAN
CAW14158OtherMEDICARE GROUP BILLING NUMBER