Provider Demographics
NPI:1164087250
Name:SAMANIEGO, KRISTOPHER MICHAEL
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:MICHAEL
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 1:2727 1/2 CALIFORNIA AVE SW APT 6
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-2159
Mailing Address - Country:US
Mailing Address - Phone:617-894-1228
Mailing Address - Fax:
Practice Address - Street 1:2727 1/2 CALIFORNIA AVE SW APT 6
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-2159
Practice Address - Country:US
Practice Address - Phone:617-894-1228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-05
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula