Provider Demographics
NPI:1386771418
Name:SAMANIEGO, ISIS (MSW)
Entity type:Individual
Prefix:MRS
First Name:ISIS
Middle Name:
Last Name:SAMANIEGO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 SAMPSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-5243
Mailing Address - Country:US
Mailing Address - Phone:916-875-1183
Mailing Address - Fax:916-875-9894
Practice Address - Street 1:3331 POWER INN RD STE 150
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3889
Practice Address - Country:US
Practice Address - Phone:916-875-1183
Practice Address - Fax:916-875-6904
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health