1093178014 NPI number — DR. MARIA GUADALUPE SAMANIEGO PH.D. CLINICAL PSYCH

Table of content: DR. MARIA GUADALUPE SAMANIEGO PH.D. CLINICAL PSYCH (NPI 1093178014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093178014 NPI number — DR. MARIA GUADALUPE SAMANIEGO PH.D. CLINICAL PSYCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAMANIEGO
Provider First Name:
MARIA
Provider Middle Name:
GUADALUPE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D. CLINICAL PSYCH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAMANIEGO
Provider Other First Name:
LUPE
Provider Other Middle Name:
REBEKA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D. CLINICAL PSYCH
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1093178014
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2565 E ALAMEDA CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80209-3201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-393-1594
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2565 E ALAMEDA CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80209-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-393-1594
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  632 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)