Provider Demographics
NPI:1235266461
Name:SAMORANO, ROGELIO SANTAMARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGELIO
Middle Name:SANTAMARIA
Last Name:SAMORANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 W EBNER PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714-1109
Mailing Address - Country:US
Mailing Address - Phone:619-993-6556
Mailing Address - Fax:
Practice Address - Street 1:1230 S CHERRYBELL STRA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-1907
Practice Address - Country:US
Practice Address - Phone:520-309-3322
Practice Address - Fax:520-309-4597
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95795207Q00000X, 2084P0800X
AZ51294207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGE406ZOtherMEDICARE PTAN
CAW14158OtherMEDICARE GROUP PTAN
CAZZZ20041ZOtherMEDICARE GROUP PTAN
CAGE406YOtherMEDICARE PTAN