Basic Information
| Provider Information | |||||||||
| NPI: | 1861833659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHEELER | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 W ARBOR DR # MC8201 | ||||||||
| Address2: | UCSD MEDICAL GROUP - MC 8201 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921031911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195435529 | ||||||||
| FaxNumber: | 6195433183 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 W ARBOR DR # MC8201 | ||||||||
| Address2: | UCSD MEDICAL GROUP - MC 8201 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921031911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195435529 | ||||||||
| FaxNumber: | 6195433183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2013 | ||||||||
| LastUpdateDate: | 05/11/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 52039 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.