Healthcare Provider Details

I. General information

NPI: 1235547944
Provider Name (Legal Business Name): SAMANTHA BOMBECK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 E MADISON AVE
EL CAJON CA
92019-1046
US

IV. Provider business mailing address

4567 KANSAS ST
SAN DIEGO CA
92116-4263
US

V. Phone/Fax

Practice location:
  • Phone: 619-588-3146
  • Fax:
Mailing address:
  • Phone: 330-501-4496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number28429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: