Healthcare Provider Details

I. General information

NPI: 1780467928
Provider Name (Legal Business Name): SAMANTHA CIARA MCGLONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 GATEWAY CENTER WAY STE 300
SAN DIEGO CA
92102-4550
US

IV. Provider business mailing address

995 GATEWAY CENTER WAY STE 300
SAN DIEGO CA
92102-4550
US

V. Phone/Fax

Practice location:
  • Phone: 619-398-2156
  • Fax:
Mailing address:
  • Phone: 619-398-2156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: