Provider Demographics
NPI:1639549447
Name:SAMUEL, EMILY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003214363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health