MEDICARE: KYRA MARINA SAMSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	D0063935	MD

General Provider Information

NPI Number	:	1366585432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYRA MARINA SAMSON MD

Provider Business Mailing Address
First Line	:	4660 PALM AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-8404
Country	:	US
Telephone Number	:	877-496-0450
Fax Number	:	619-662-5375

Provider Business Practice Location Address
First Line	:	4660 PALM AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-8404
Country	:	US
Telephone Number	:	877-496-0450
Fax Number	:	619-662-5375

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	12/01/2021

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