Provider Demographics
NPI:1801361829
Name:SAMANO, CAROLINA (MS)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:SAMANO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:
Other - Last Name:SANDOVAL GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5080 CAMINO DEL ARROYO APT 471
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3180
Mailing Address - Country:US
Mailing Address - Phone:951-823-3872
Mailing Address - Fax:
Practice Address - Street 1:5080 CAMINO DEL ARROYO APT 471
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3180
Practice Address - Country:US
Practice Address - Phone:951-823-3872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109928106H00000X
CA132071106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist