Healthcare Provider Details

I. General information

NPI: 1609979665
Provider Name (Legal Business Name): MARION Z SANTORA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 SOQUEL DR
SANTA CRUZ CA
95065-1705
US

IV. Provider business mailing address

P.O. BOX 56
APTOS CA
95001
US

V. Phone/Fax

Practice location:
  • Phone: 831-457-7038
  • Fax: 831-457-7195
Mailing address:
  • Phone: 831-457-7038
  • Fax: 831-457-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG28088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: