Healthcare Provider Details

I. General information

NPI: 1972853596
Provider Name (Legal Business Name): GILEANA SANTANA RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DR BLDG 2 SUITE 201
AUSTIN TX
78758-5387
US

IV. Provider business mailing address

2217 PARK BEND DR STE 400
AUSTIN TX
78758-5674
US

V. Phone/Fax

Practice location:
  • Phone: 512-835-8100
  • Fax: 512-835-8101
Mailing address:
  • Phone: 512-730-0000
  • Fax: 512-835-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA08422
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: