Provider Demographics
NPI:1902927122
Name:DAMBROCIA, SAMUEL L JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:L
Last Name:DAMBROCIA
Suffix:JR
Gender:M
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:1965 VISTA CAUDAL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3915
Mailing Address - Country:US
Mailing Address - Phone:949-718-9698
Mailing Address - Fax:949-757-1782
Practice Address - Street 1:7 CORPORATE PARK
Practice Address - Street 2:SUITE 250
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5107
Practice Address - Country:US
Practice Address - Phone:949-222-0811
Practice Address - Fax:949-757-1782
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY11148103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist