Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | E4932 | TX |
NPI | 1053415646 |
---|---|
Provider Name | Carlos Humberto Santillan |
First Address | Amarillo, TX 79121-1807 |
Second Address | Amarillo, TX 79106-4148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000W9666 | (05) | NM |
B26172 | (02) |