Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 01060301 | IN |
NPI | 1194837575 |
---|---|
Provider Name | Dr. Krista I Santos |
First Address | Indianapolis, IN 46254 |
Second Address | Indianapolis, IN 46254 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000364651 | ANTHEM (01) | |
5628778 | FIRST HEALTH (01) | |
6185773002 | CIGNA (01) |