Provider Demographics
NPI:1053707422
Name:FRIEND, SAMANTHA (MD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:FRIEND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 GILMAN DR
Mailing Address - Street 2:9116A
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-9116
Mailing Address - Country:US
Mailing Address - Phone:858-534-4040
Mailing Address - Fax:858-822-0231
Practice Address - Street 1:9500 GILMAN DR
Practice Address - Street 2:9116A
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093
Practice Address - Country:US
Practice Address - Phone:858-534-4040
Practice Address - Fax:858-822-0231
Is Sole Proprietor?:No
Enumeration Date:2015-04-12
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA147892208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program