Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | F1501 | TX |
NPI | 1003859166 |
---|---|
Provider Name | Maria Del Rosario De Los Santos |
First Address | Corpus Christi, TX 78411 |
Second Address | Corpus Christi, TX 78413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
817604 | BCBS (01) | TX |
851111 | BLUE CROSS (01) | TX |
B22155 | (02) |