Basic Information
| Provider Information | |||||||||
| NPI: | 1225586233 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JORGE C SAMANIEGO JR MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1177 QUEEN ST | ||||||||
| Address2: | APT. # 2306 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968144138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085371217 | ||||||||
| FaxNumber: | 8085971597 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 PUNCHBOWL ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086911000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2016 | ||||||||
| LastUpdateDate: | 10/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | SAMANIEGO | ||||||||
| AuthorizedOfficialFirstName: | JORGE | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8085371217 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MD-9469 | HI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.