MEDICARE: DR. RUTH SAMAD PHD

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	103TC0700X	Clinical Psychologist	PSY11658	CA

General Provider Information

NPI Number	:	1528146933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUTH SAMAD PHD

Provider Business Mailing Address
First Line	:	12842 FRANCINE CT
Second Line	:
City	:	POWAY
State	:	CA
Zip	:	92064-4109
Country	:	US
Telephone Number	:	858-733-2254
Fax Number	:	858-513-8233

Provider Business Practice Location Address
First Line	:	9683 TIERRA GRANDE ST
Second Line	:	SUITE #105
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-6503
Country	:	US
Telephone Number	:	858-733-2254
Fax Number	:

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	06/01/2009

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