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General NPI Number Information
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NPI Number | 1740961507
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Entity Type | Individual
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Provider Name | SAMANTHA RAE SIMS PSYD
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Gender | Female
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 477 N EL CAMINO REAL STE D306
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City | ENCINITAS
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State | CA
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Zip | 92024-1370
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Country | US
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Telephone | 858-966-8461
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Fax |
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Provider Business Mailing Address
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Address Line | 3020 CHILDRENS WAY # MC5170
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City | SAN DIEGO
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State | CA
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Zip | 92123-4223
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Country | US
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Telephone | 858-576-1700
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY35244
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License Number State | CA
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