Healthcare Provider Details

I. General information

NPI: 1760748149
Provider Name (Legal Business Name): CHRISTINE SUZANNE SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL # GW12
MADERA CA
93636-8761
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL # SC05
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-5068
  • Fax: 559-353-5426
Mailing address:
  • Phone: 559-353-5068
  • Fax: 559-353-5426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A13162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: