Provider Demographics
NPI:1285389601
Name:NOEL, SAMANTHA DUFFY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:DUFFY
Last Name:NOEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:SACHI TAKASHIMA
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:477 N EL CAMINO REAL STE A306
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1350
Mailing Address - Country:US
Mailing Address - Phone:760-942-0118
Mailing Address - Fax:
Practice Address - Street 1:477 N EL CAMINO REAL STE A306
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1350
Practice Address - Country:US
Practice Address - Phone:760-942-0118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60754363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA60754OtherCALIFORNIA PHYSICIAN ASSISTANT BOARD