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General NPI Number Information
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NPI Number | 1750173555
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Entity Type | Individual
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Provider Name | SAMANTHA SELKET THOMAS
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Gender | Female
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 254 AVOCADO AVE
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City | EL CAJON
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State | CA
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Zip | 92020-4604
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Country | US
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Telephone | 619-315-3792
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Fax |
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Provider Business Mailing Address
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Address Line | 4532 TERRY LN
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City | LA MESA
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State | CA
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Zip | 91942-5849
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Country | US
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Telephone | 805-705-2658
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | DEH2024-FBAP-004675
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License Number State | CA
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