Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174V00000X | Clinical Ethicist |
NPI | 1801253562 |
---|---|
Provider Name | Edward Santellano |
First Address | San Jose, CA 95119-1939 |
Second Address | San Jose, CA 95119-1939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2016 |
Last Update Date | 25/01/2016 |