Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 20842 | TX |
NPI | 1023105814 |
---|---|
Provider Name | Dr. Lori Lee Correia Santos |
First Address | Vancouver, BC V6Z3A5 |
Second Address | El Paso, TX 79936-6829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 28/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017554 | (05) | NM |
1381372 | UNITED CONCORDIA (01) | TX |
150189201 | (05) | TX |