Active NPI
Samir B Faragallah, DC
- Orthopedic Chiropractor
- San Diego, CA
National Provider Identifier
1245339159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Chiropractor
- License
- 10642
- Practice address
- 3505 Camino del Rio S Ste 120
San Diego, CA 92108-4015 - Phone
- (619) 683-2220
- Fax
- (619) 677-2668
- NPI assigned
- Sep 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Chiropractor | 111NX0800X | 10642 | CA | Primary |
Addresses
Primary practice location
3505 Camino del Rio S Ste 120
San Diego, CA 92108-4015
Mailing address
3505 Camino del Rio S Ste 120
San Diego, CA 92108-4015
Phone (619) 683-2220
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DC0106420 | Other | CA | BLUE SHIELD OF CA |
| DC0106420 | Medicaid | CA | |
| 10642 | Other | CA | CA STATE LC # CHIROPRACTI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720396800000",
"number": "1245339159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3505 CAMINO DEL RIO S STE 120",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921084015",
"telephone_number": "619-683-2220",
"fax_number": "619-441-8339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3505 CAMINO DEL RIO S STE 120",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921084015",
"telephone_number": "619-683-2220",
"fax_number": "619-677-2668"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARAGALLAH",
"first_name": "SAMIR",
"middle_name": "B",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-21",
"last_updated": "2024-07-08",
"certification_date": "2024-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "111NX0800X",
"taxonomy_group": "",
"desc": "Chiropractor, Orthopedic",
"state": "CA",
"license": "10642",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF CA",
"identifier": "DC0106420",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DC0106420",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CA STATE LC # CHIROPRACTI",
"identifier": "10642",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.