Provider Demographics
NPI:1992833099
Name:SAMUEL, SAMUEL I (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:I
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6250
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93912-6250
Mailing Address - Country:US
Mailing Address - Phone:865-765-8224
Mailing Address - Fax:
Practice Address - Street 1:1519 CONSTITUTION BLVD APT 201
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3150
Practice Address - Country:US
Practice Address - Phone:865-765-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA563602081P0301X, 2084A0401X, 261QM0855X
CA1650352084A0401X, 2084P0301X, 2084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury Medicine
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health