Provider Demographics
NPI:1639297740
Name:HENRY SAMTOY MD INC
Entity Type:Organization
Organization Name:HENRY SAMTOY MD INC
Other - Org Name:HENRY SAMTOY MD INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMTOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-442-3446
Mailing Address - Street 1:1240 BROADWAY
Mailing Address - Street 2:STE 210
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4947
Mailing Address - Country:US
Mailing Address - Phone:619-442-3446
Mailing Address - Fax:619-442-3156
Practice Address - Street 1:1240 BROADWAY
Practice Address - Street 2:STE 210
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4947
Practice Address - Country:US
Practice Address - Phone:619-442-3446
Practice Address - Fax:619-442-3446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34065207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ79384ZOtherBLUE SHIELD
CA00C340651Medicaid
ZZZ79384ZOtherBLUE SHIELD
CAW3828Medicare PIN