Healthcare Provider Details

I. General information

NPI: 1659697456
Provider Name (Legal Business Name): RENE SANTOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JUAN ESCUTIA # 363-2
JUAREZ CHIHUAHUA
32300
MX

IV. Provider business mailing address

PO BOX 12385
EL PASO TX
79913-0385
US

V. Phone/Fax

Practice location:
  • Phone: 526566134116
  • Fax:
Mailing address:
  • Phone: 915-449-8589
  • Fax: 915-996-9913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number327326
License Number StateZZ

VIII. Authorized Official

Name: RENE F. SANTOS
Title or Position: OWNER
Credential: DDS
Phone: 915-726-0929