Healthcare Provider Details

I. General information

NPI: 1790990802
Provider Name (Legal Business Name): RICARDO DE LOS SANTOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 WILLIAMS ST
EAGLE PASS TX
78852-5126
US

IV. Provider business mailing address

710 WILLIAMS ST
EAGLE PASS TX
78852-5126
US

V. Phone/Fax

Practice location:
  • Phone: 830-773-1103
  • Fax: 830-757-8366
Mailing address:
  • Phone: 830-773-1103
  • Fax: 830-757-8366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF3442
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: