Healthcare Provider Details

I. General information

NPI: 1396675955
Provider Name (Legal Business Name): SAMARA ALGHAZALI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 FLANDERS DR
SAN DIEGO CA
92121-3906
US

IV. Provider business mailing address

1317 HIDDEN KNOLL CT
EL CAJON CA
92019-3658
US

V. Phone/Fax

Practice location:
  • Phone: 858-457-4199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: