Healthcare Provider Details

I. General information

NPI: 1578157228
Provider Name (Legal Business Name): SAMUEL CAUBLE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 JAMACHA RD
EL CAJON CA
92019-2448
US

IV. Provider business mailing address

PO BOX 2696
EL CAJON CA
92021-0696
US

V. Phone/Fax

Practice location:
  • Phone: 619-579-1625
  • Fax: 619-579-1611
Mailing address:
  • Phone: 858-312-6444
  • Fax: 858-312-6446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT299517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: