Healthcare Provider Details

I. General information

NPI: 1174897706
Provider Name (Legal Business Name): SAMANTHA SATRIANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 W DIDIER AVE
BELEN NM
87002-3160
US

IV. Provider business mailing address

PO BOX 577
BELEN NM
87002-0577
US

V. Phone/Fax

Practice location:
  • Phone: 505-312-0040
  • Fax:
Mailing address:
  • Phone: 505-373-4072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11599
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: