Healthcare Provider Details

I. General information

NPI: 1003220500
Provider Name (Legal Business Name): JOEL SAMANIEGO PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41715 ENTERPRISE CIR N STE 205
TEMECULA CA
92590-5623
US

IV. Provider business mailing address

41715 ENTERPRISE CIR N STE 205
TEMECULA CA
92590-5623
US

V. Phone/Fax

Practice location:
  • Phone: 915-276-7691
  • Fax:
Mailing address:
  • Phone: 915-276-7691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: