Healthcare Provider Details

I. General information

NPI: 1801253562
Provider Name (Legal Business Name): EDWARD SANTELLANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 MANILA DR
SAN JOSE CA
95119-1939
US

IV. Provider business mailing address

386 MANILA DR
SAN JOSE CA
95119-1939
US

V. Phone/Fax

Practice location:
  • Phone: 408-520-6824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174V00000X
TaxonomyClinical Ethicist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: