Provider Demographics
NPI:1396230298
Name:CAINE, SAMUEL (DPM)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:CAINE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 GROSSMONT CENTER DR STE 510
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3024
Mailing Address - Country:US
Mailing Address - Phone:619-303-7130
Mailing Address - Fax:
Practice Address - Street 1:8851 CENTER DR STE 406
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3017
Practice Address - Country:US
Practice Address - Phone:619-465-3200
Practice Address - Fax:619-465-3700
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5972213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery