Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 2009001296 | MO |
NPI | 1023299393 |
---|---|
Provider Name | Dr. Carlos Alfonso Quilala Santos |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63141-6350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2007 |
Last Update Date | 27/10/2015 |