Healthcare Provider Details

I. General information

NPI: 1578097978
Provider Name (Legal Business Name): ISRAEL SANTANDER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S BUENA VISTA ST STE 305
BURBANK CA
91505-4516
US

IV. Provider business mailing address

201 S BUENA VISTA ST STE 305
BURBANK CA
91505-4516
US

V. Phone/Fax

Practice location:
  • Phone: 818-848-5588
  • Fax:
Mailing address:
  • Phone: 818-848-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103301301
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: