Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | L4333 | TX |
NPI | 1023016326 |
---|---|
Provider Name | Christina Desantos |
First Address | El Paso, TX 79902-5807 |
Second Address | El Paso, TX 79902-5807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 21/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00508U | MEDICARE GROUP PIN (01) | TX |
1732935 | (05) | TX |
I27888 | (02) | TX |