Provider Demographics
NPI:1306432612
Name:MATLOB, SAMA
Entity type:Individual
Prefix:
First Name:SAMA
Middle Name:
Last Name:MATLOB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3082 GOLF CREST RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-5106
Mailing Address - Country:US
Mailing Address - Phone:747-229-1361
Mailing Address - Fax:
Practice Address - Street 1:7393 JACKSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-2316
Practice Address - Country:US
Practice Address - Phone:619-465-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist