Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 2763727 | ZZ |
NPI | 1235677410 |
---|---|
Provider Name | Hector Santillana Marin |
First Address | La Jolla, CA 92037-9123 |
Second Address | Tijuana, BAJA CALIFORNIA 22010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2017 |
Last Update Date | 07/02/2017 |