MEDICARE: MARIA CONCEPCION SAMANO-PATINO CRM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	20-CRM-224	OR

General Provider Information

NPI Number	:	1134710668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA CONCEPCION SAMANO-PATINO CRM

Provider Business Mailing Address
First Line	:	290 FAIR OAKS ST
Second Line	:
City	:	FALLS CITY
State	:	OR
Zip	:	97344-9725
Country	:	US
Telephone Number	:	503-507-4186
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 FAIR OAKS ST
Second Line	:
City	:	FALLS CITY
State	:	OR
Zip	:	97344-9725
Country	:	US
Telephone Number	:	503-507-4186
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2021
Last Update Date	:	01/27/2021

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