Individual provider Active NPI

Ruth Samad, PHD

  • Clinical Psychologist
  • San Diego, CA
National Provider Identifier
1528146933
Registry record updated Jun 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY11658 Issued in CA
Practice address
9683 Tierra Grande St
Suite #105
San Diego, CA 92126-6503
Phone
(858) 733-2254
NPI assigned
Nov 2, 2006
Last updated
Jun 1, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY11658 CA Primary

Addresses

Primary practice location

9683 Tierra Grande St
Suite #105
San Diego, CA 92126-6503

Mailing address

12842 Francine CT
Poway, CA 92064-4109
Phone (858) 733-2254

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
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY11658CAMDClinical Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243814400000",
    "number": "1528146933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12842 FRANCINE CT",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920644109",
            "telephone_number": "858-733-2254",
            "fax_number": "858-513-8233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9683 TIERRA GRANDE ST",
            "address_2": "SUITE #105",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921266503",
            "telephone_number": "858-733-2254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMAD",
        "first_name": "RUTH",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-02",
        "last_updated": "2009-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY11658",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jun 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.