Healthcare Provider Details

I. General information

NPI: 1174944789
Provider Name (Legal Business Name): SAMANTHA YEAGER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA SCHIAVON

II. Dates (important events)

Enumeration Date: 12/27/2013
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 LA JOLLA VILLAGE DR # 116B
SAN DIEGO CA
92161-0002
US

IV. Provider business mailing address

3350 LA JOLLA VILLAGE DR # 116B
SAN DIEGO CA
92161-0002
US

V. Phone/Fax

Practice location:
  • Phone: 858-833-5382
  • Fax:
Mailing address:
  • Phone: 858-833-5382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: