MEDICARE: JACOBO LEOPOLDO SANTOLAYA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MT211942	PA
2	2080P0206X	Pediatric Gastroenterology Physician	S3453	TX

General Provider Information

NPI Number	:	1215386099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOBO LEOPOLDO SANTOLAYA M.D.

Provider Business Mailing Address
First Line	:	5747 SADLER CIR APT 2110
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-6602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 MEDICAL DISTRICT DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235
Country	:	US
Telephone Number	:	214-456-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	03/02/2026

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