Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 17593 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 17593 | CA |
NPI | 1124178504 |
---|---|
Provider Name | Dr. Jorge Paul Santana |
First Address | Brea, CA 92821-3936 |
Second Address | Brea, CA 92821-3936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 20/11/2007 |