Provider Demographics
NPI:1790746154
Name:SAMANIEGO-PICOTA, MILAGROS DALGIR (MD)
Entity type:Individual
Prefix:
First Name:MILAGROS
Middle Name:DALGIR
Last Name:SAMANIEGO-PICOTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MILLIE
Other - Middle Name:
Other - Last Name:SAMANIEGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3821 MASTHEAD ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4679
Mailing Address - Country:US
Mailing Address - Phone:505-998-7400
Mailing Address - Fax:505-998-7441
Practice Address - Street 1:313 W COUNTRY CLUB RD STE 12
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5804
Practice Address - Country:US
Practice Address - Phone:575-627-5828
Practice Address - Fax:575-627-5835
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093628207R00000X, 207RN0300X
WI46860207RN0300X
NMMD2024-1056207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34522000Medicaid
G31312Medicare UPIN
MIG31312Medicare UPIN
WI034F15875Medicare ID - Type Unspecified