Healthcare Provider Details

I. General information

NPI: 1174765572
Provider Name (Legal Business Name): RAMIRO DE LOS SANTOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

580 HILLCREST BLVD
EAGLE PASS TX
78852-4328
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-6225
  • Fax: 505-272-5184
Mailing address:
  • Phone: 830-776-4948
  • Fax: 830-757-8622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: