Healthcare Provider Details

I. General information

NPI: 1740263706
Provider Name (Legal Business Name): NANCY D SANTANA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 S STAPLEY DR STE. 101
MESA AZ
85204-6681
US

IV. Provider business mailing address

25500 N NORTERRA DR BLDG. B
PHOENIX AZ
85085-8200
US

V. Phone/Fax

Practice location:
  • Phone: 480-464-8500
  • Fax: 480-464-6966
Mailing address:
  • Phone: 623-277-1000
  • Fax: 602-906-2789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA07901000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35559
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: