Provider Demographics
NPI:1003220500
Name:SAMANIEGO, JOEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:SAMANIEGO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41715 ENTERPRISE CIR N STE 205
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5623
Mailing Address - Country:US
Mailing Address - Phone:844-737-3638
Mailing Address - Fax:619-403-9496
Practice Address - Street 1:9265 SKY PARK COURT
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4375
Practice Address - Country:US
Practice Address - Phone:844-737-3638
Practice Address - Fax:619-403-9496
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 101Y00000X
CA35416103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor