Active NPI
Gayle Samples, MFT
- Marriage & Family Therapist
- San Dimas, CA
National Provider Identifier
1902193998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC40871
- Practice address
- 1100 W Covina Blvd
San Dimas, CA 91773-3203 - Phone
- (909) 599-5433
- Fax
- (909) 706-3099
- NPI assigned
- Jun 29, 2011
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC40871 | CA | Primary |
Addresses
Primary practice location
1100 W Covina Blvd
San Dimas, CA 91773-3203
Mailing address
1100 W Covina Blvd
San Dimas, CA 91773-3203
Phone (909) 599-5433
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC40871 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309305600000",
"number": "1902193998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 W COVINA BLVD",
"city": "SAN DIMAS",
"state": "CA",
"postal_code": "917733203",
"telephone_number": "909-599-5433",
"fax_number": "909-706-3099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 W COVINA BLVD",
"city": "SAN DIMAS",
"state": "CA",
"postal_code": "917733203",
"telephone_number": "909-599-5433",
"fax_number": "909-706-3099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMPLES",
"first_name": "GAYLE",
"name_prefix": "Dr.",
"credential": "MFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-29",
"last_updated": "2011-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC40871",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Dimas, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.