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General NPI Number Information
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NPI Number | 1124828843
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Entity Type | Individual
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Provider Name | SAMANTHA NEMIROV
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Gender | Female
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 4241 JUTLAND DR STE 207
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City | SAN DIEGO
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State | CA
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Zip | 92117-3653
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Country | US
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Telephone | 619-733-6414
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Fax |
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Provider Business Mailing Address
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Address Line | 3288 5TH AVE APT 323
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City | SAN DIEGO
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State | CA
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Zip | 92103-5751
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APCC14192
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License Number State | CA
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