Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3107 | CT |
NPI | 1013558139 |
---|---|
Provider Name | Dr. Leticia Santa |
First Address | Wichita, KS 67212-6036 |
Second Address | Wichita, KS 67218-3210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2019 |
Last Update Date | 30/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3107 | FEDERAL GOVERNMENT (VA) (01) | CT |