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General NPI Number Information
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NPI Number | 1336596030
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Entity Type | Organization
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Legal Business Name | DSANTANNA, LLC
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | 3101 S AUSTIN AVE
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City | GEORGETOWN
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State | TX
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Zip | 78626-7541
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Country | US
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Telephone | 512-819-1100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 82078
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City | BATON ROUGE
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State | LA
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Zip | 70884-2078
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Country | US
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Telephone | 225-243-4554
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Fax | 225-271-8700
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEBORAH DE SANT'ANNA
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Credential | NP
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Telephone | 512-660-3044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP130352
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License Number State | TX
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