MEDICARE: SAM DAVID SCHAFF I

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	2255A2300X	Athletic Trainer
2	2255A2300X	Athletic Trainer	2000040994	CA
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1396386306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAM DAVID SCHAFF I

Provider Business Mailing Address
First Line	:	3210 OAKRIDGE AVE APT 2110
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79407-1860
Country	:	US
Telephone Number	:	720-587-9734
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 GILMAN DR
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92093-5004
Country	:	US
Telephone Number	:	858-534-3557
Fax Number	:

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

Provider Enumeration Date	:	10/01/2019
Last Update Date	:	02/05/2026

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