Provider Demographics
NPI:1477636215
Name:SAMANIEGO, JORGE CRUZ JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:CRUZ
Last Name:SAMANIEGO
Suffix:JR
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 1:1177 QUEEN ST
Mailing Address - Street 2:APT. # 2306
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4138
Mailing Address - Country:US
Mailing Address - Phone:808-224-7211
Mailing Address - Fax:808-597-1597
Practice Address - Street 1:1301 PUNCHBOWL STREET
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2499
Practice Address - Country:US
Practice Address - Phone:808-691-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-9469207R00000X, 207RG0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN
HIG36521Medicare UPIN
HIG36521Medicare UPIN
HI0000BFDBXMedicare ID - Type Unspecified