Healthcare Provider Details

I. General information

NPI: 1609860923
Provider Name (Legal Business Name): RENE' SANTOS LASANTA D.C., FICPA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 CRAWFORD ST SUITE 210
HOUSTON TX
77002-8942
US

IV. Provider business mailing address

2101 CRAWFORD ST SUITE 210
HOUSTON TX
77002-8942
US

V. Phone/Fax

Practice location:
  • Phone: 713-654-2106
  • Fax: 713-654-2109
Mailing address:
  • Phone: 713-654-2106
  • Fax: 713-654-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9024
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: