Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 12531 | PR |
NPI | 1003985417 |
---|---|
Provider Name | Dr. Carlos Manuel De Sanctis |
First Address | Gallup, NM 87305-1337 |
Second Address | Gallup, NM 87301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 09/03/2012 |