Individual
SAMIR B FARAGALLAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
3505 CAMINO DEL RIO S STE 120, SAN DIEGO, CA 92108-4015
(619) 683-2220
(619) 677-2668
Mailing address
3505 CAMINO DEL RIO S STE 120, SAN DIEGO, CA 92108-4015
(619) 683-2220
(619) 441-8339
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
10642
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10642
CA STATE LC # CHIROPRACTI
CA
01
—
DC0106420
BLUE SHIELD OF CA
CA
05
—
DC0106420
—
CA
Enumeration date
09/21/2006
Last updated
07/08/2024
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