Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | R4834 | TX |
NPI | 1184989428 |
---|---|
Provider Name | Dr. Santiago Enrique Encalada |
First Address | Corpus Christi, TX 78411-1721 |
Second Address | Corpus Christi, TX 78411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2012 |
Last Update Date | 14/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1184989428 | (05) | WI |
378085001 | (05) | TX |