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General NPI Number Information
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NPI Number | 1396904165
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Entity Type | Individual
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Provider Name | MICHAEL R SAMKO PHD
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Gender | Male
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 2125 S EL CAMINO REAL STE 206
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City | OCEANSIDE
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State | CA
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Zip | 92054-6260
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Country | US
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Telephone | 760-721-1111
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Fax | 858-481-9791
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Provider Business Mailing Address
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Address Line | 319 GLENMONT DR
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City | SOLANA BEACH
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State | CA
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Zip | 92075-1308
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Country | US
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Telephone | 760-721-1111
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Fax | 858-481-9791
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY5420
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License Number State | CA
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