Provider Demographics
NPI:1003220500
Name:SAMANIEGO, JOEL
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:SAMANIEGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 RONSON CT STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1805
Mailing Address - Country:US
Mailing Address - Phone:915-276-7691
Mailing Address - Fax:
Practice Address - Street 1:4849 RONSON CT STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1805
Practice Address - Country:US
Practice Address - Phone:619-837-7269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor