MEDICARE: MILAGROS DALGIR SAMANIEGO-PICOTA MD

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	207R00000X	Internal Medicine Physician	4301093628	MI
2	207RN0300X	Nephrology Physician	46860	WI
3	207RN0300X	Nephrology Physician	4301093628	MI
4	207RN0300X	Nephrology Physician	MD2024-1056	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790746154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILAGROS DALGIR SAMANIEGO-PICOTA MD

Provider Business Mailing Address
First Line	:	3821 MASTHEAD ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4679
Country	:	US
Telephone Number	:	505-998-7400
Fax Number	:	505-998-7441

Provider Business Practice Location Address
First Line	:	313 W COUNTRY CLUB RD STE 12
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-5804
Country	:	US
Telephone Number	:	575-627-5828
Fax Number	:	575-627-5835

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	10/30/2024

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Directions to “ MILAGROS DALGIR SAMANIEGO-PICOTA MD” Practice Location

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