Healthcare Provider Details

I. General information

NPI: 1780391110
Provider Name (Legal Business Name): JAVIER MARTIN SANTOS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 CREEKSIDE XING STE 218
NEW BRAUNFELS TX
78130-4565
US

IV. Provider business mailing address

PO BOX 5730
BELFAST ME
04915-5700
US

V. Phone/Fax

Practice location:
  • Phone: 210-798-4311
  • Fax: 210-798-4317
Mailing address:
  • Phone: 888-402-7256
  • Fax: 888-902-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1100749
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: