Provider Demographics
NPI:1023208923
Name:ANGUIANO, SAMANTHA ESTEFANIA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ESTEFANIA
Last Name:ANGUIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 N LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1733
Mailing Address - Country:US
Mailing Address - Phone:562-570-7195
Mailing Address - Fax:
Practice Address - Street 1:3205 N LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1733
Practice Address - Country:US
Practice Address - Phone:562-570-7195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist