Healthcare Provider Details

I. General information

NPI: 1629257191
Provider Name (Legal Business Name): EDUARDO SANTOS UY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9717 SIERRA AVE
FONTANA CA
92335-6716
US

IV. Provider business mailing address

9717 SIERRA AVE
FONTANA CA
92335-6716
US

V. Phone/Fax

Practice location:
  • Phone: 909-822-3400
  • Fax: 909-886-8881
Mailing address:
  • Phone: 909-822-3400
  • Fax: 909-886-8881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: EDUARDO SANTOS UY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-886-8888