Individual
MR. ITALO AUGUSTO SAMANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
4242 MEDICAL DR, SUITE 6300, SAN ANTONIO, TX 78229-5640
(210) 614-8400
(210) 614-8165
Mailing address
3019 FALL WAY DR, SAN ANTONIO, TX 78247-3233
(210) 495-6346
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
23724
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-0624198
TAX ID # FOR GROUP
TX
05
—
128813606
—
TX
01
—
151188301
MEDICAID GROUP
TX
Enumeration date
05/31/2006
Last updated
09/12/2013
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