=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427399625
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. SANTOS O. BARBOSA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2013
-----------------------------------------------------
Last Update Date | 03/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 E. MILE 11 N.
-----------------------------------------------------
City | WESLACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-639-7568
-----------------------------------------------------
Fax | 956-351-5984
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 E MILE 11 N
-----------------------------------------------------
City | WESLACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78596-5559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-639-7568
-----------------------------------------------------
Fax | 956-351-5984
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171WH0202X
-----------------------------------------------------
Taxonomy Name | Home Modifications Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------