Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A29516 | CA |
Y | 207QA0505X | Family Doctor - Adult Medicine | A29516 | CA |
NPI | 1265547608 |
---|---|
Provider Name | Pacifico C. Santos |
First Address | San Jose, CA 95116-1601 |
Second Address | San Jose, CA 95116-1601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 07/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A25795 | (02) | CA |