Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 54594 | WI |
N | 207Q00000X | Family Doctor | 54594 | WI |
Y | 207Q00000X | Family Doctor | 58448 | MN |
N | 207Q00000X | Family Doctor | MT189896 | PA |
NPI | 1013103332 |
---|---|
Provider Name | Charito M Santos |
First Address | Andover, MN 55304-7608 |
Second Address | Andover, MN 55304-7608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2007 |
Last Update Date | 01/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013103332 | (05) | WI |