Healthcare Provider Details

I. General information

NPI: 1346990470
Provider Name (Legal Business Name): SAMANTHA SHWE MESKO MD, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA SHWE DANIEL MD

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 CARMEL MOUNTAIN RD STE 206
SAN DIEGO CA
92130-4861
US

IV. Provider business mailing address

5550 CARMEL MOUNTAIN RD STE 206
SAN DIEGO CA
92130-4861
US

V. Phone/Fax

Practice location:
  • Phone: 209-981-2383
  • Fax:
Mailing address:
  • Phone: 858-943-2540
  • Fax: 858-252-2053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA188649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: