Healthcare Provider Details

I. General information

NPI: 1134045412
Provider Name (Legal Business Name): JOSEPH VINCENT SAMBADE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4699 CANYON ROAD
SAN DIEGO CA
92123
US

IV. Provider business mailing address

5454 MARY LANE DR
SAN DIEGO CA
92115-1327
US

V. Phone/Fax

Practice location:
  • Phone: 858-715-0678
  • Fax:
Mailing address:
  • Phone: 858-715-0678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: