Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | A52954 | CA |
NPI | 1073577573 |
---|---|
Provider Name | Jose M. R. Santos |
First Address | Modesto, CA 95350-5513 |
Second Address | Modesto, CA 95350-5513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 04/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A529540 | (05) | CA |
F69499 | (02) | CA |
GR0099870 | (05) | CA |