MEDICARE: SAMANTHA MIDWOOD

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	106H00000X	Marriage & Family Therapist	148609	CA

General Provider Information

NPI Number	:	1558193607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA MIDWOOD

Provider Business Mailing Address
First Line	:	10650 TREENA ST STE 103
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-2436
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10650 TREENA ST STE 103
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-2436
Country	:	US
Telephone Number	:	858-717-9145
Fax Number	:

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

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/16/2024

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Directions to “ SAMANTHA MIDWOOD ” Practice Location

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