Healthcare Provider Details

I. General information

NPI: 1407495575
Provider Name (Legal Business Name): DOCTOR SAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N MILITARY TRL STE 355
BOCA RATON FL
33431-6312
US

IV. Provider business mailing address

2600 N MILITARY TRL STE 355
BOCA RATON FL
33431-6330
US

V. Phone/Fax

Practice location:
  • Phone: 561-510-9150
  • Fax:
Mailing address:
  • Phone: 561-510-9150
  • Fax: 561-600-9655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMANTHA SALTZ
Title or Position: OWNER
Credential: MD
Phone: 561-715-1242