Healthcare Provider Details

I. General information

NPI: 1447182092
Provider Name (Legal Business Name): DR. DRISS SAMMARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3767 AVOCADO BLVD
LA MESA CA
91941-7301
US

IV. Provider business mailing address

3767 AVOCADO BLVD
LA MESA CA
91941-7301
US

V. Phone/Fax

Practice location:
  • Phone: 619-729-2323
  • Fax: 619-729-2411
Mailing address:
  • Phone: 619-729-2323
  • Fax: 619-729-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: