=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376408492
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMANTHA PATRICIA KANJOKA-BANDA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2025
-----------------------------------------------------
Last Update Date | 12/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 208 MILLS AVE # 228
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87701-4125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-302-3222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 605 NATIONAL AVE APT 2
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87701-4277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-429-8876
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------