MEDICARE: SAMA NABBOUD

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1881260321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMA NABBOUD

Provider Business Mailing Address
First Line	:	343 E MAIN ST STE 102
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-3942
Country	:	US
Telephone Number	:	619-756-5267
Fax Number	:

Provider Business Practice Location Address
First Line	:	343 E MAIN ST STE 102
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-3942
Country	:	US
Telephone Number	:	619-756-5267
Fax Number	:

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

Provider Enumeration Date	:	06/03/2021
Last Update Date	:	06/03/2021

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Directions to “ SAMA NABBOUD ” Practice Location

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