Provider Demographics
NPI:1770734105
Name:SAMAAN, GINA (PSYD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:SAMAAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:FAHMI
Other - Last Name:GRACE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1200 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3208
Mailing Address - Country:US
Mailing Address - Phone:650-742-3985
Mailing Address - Fax:650-742-2398
Practice Address - Street 1:1200 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3208
Practice Address - Country:US
Practice Address - Phone:650-742-3985
Practice Address - Fax:650-742-2398
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21580302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization