Provider Demographics
NPI:1528418472
Name:SAMANIEGO, PEDRO IV (DC)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:
Last Name:SAMANIEGO
Suffix:IV
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:PETE
Other - Middle Name:
Other - Last Name:SAMANIEGO
Other - Suffix:IV
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-723-4000
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor