Provider Demographics
NPI:1578238580
Name:EMILY SAMUEL
Entity Type:Organization
Organization Name:EMILY SAMUEL
Other - Org Name:EMILY SAMUEL, PMHNP-BC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:415-849-2466
Mailing Address - Street 1:888 PROSPECT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4261
Mailing Address - Country:US
Mailing Address - Phone:415-849-2466
Mailing Address - Fax:415-376-4529
Practice Address - Street 1:888 PROSPECT ST STE 200
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4261
Practice Address - Country:US
Practice Address - Phone:415-849-2466
Practice Address - Fax:415-376-4529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty