Provider Demographics
NPI:1134710668
Name:SAMANO-PATINO, MARIA CONCEPCION (CRM)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:CONCEPCION
Last Name:SAMANO-PATINO
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 FAIR OAKS ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97344-9725
Mailing Address - Country:US
Mailing Address - Phone:503-507-4186
Mailing Address - Fax:
Practice Address - Street 1:290 FAIR OAKS ST
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:OR
Practice Address - Zip Code:97344-9725
Practice Address - Country:US
Practice Address - Phone:503-507-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20-CRM-224175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist