Healthcare Provider Details

I. General information

NPI: 1497813968
Provider Name (Legal Business Name): SAMUEL KUGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 EUCLID AVE STE 306
NATIONAL CITY CA
91950-8902
US

IV. Provider business mailing address

1342 RHODA DR
LA JOLLA CA
92037-5223
US

V. Phone/Fax

Practice location:
  • Phone: 619-472-2600
  • Fax: 619-472-5700
Mailing address:
  • Phone: 619-472-2600
  • Fax: 619-472-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA54412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: