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General NPI Number Information
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NPI Number | 1558688325
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Entity Type | Individual
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Provider Name | MRS. ELDA ANTONIA DESANTIAGO
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Gender | Female
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Dates
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Enumeration Date | 05/03/2010
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Last Update Date | 05/03/2010
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Provider Practice Location Address
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Address Line | 2526 82ND ST STE B
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City | LUBBOCK
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State | TX
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Zip | 79423-2223
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Country | US
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Telephone | 806-745-5413
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Fax | 806-745-5580
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Provider Business Mailing Address
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Address Line | 2526 82ND ST STE B
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City | LUBBOCK
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State | TX
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Zip | 79423-2223
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Country | US
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Telephone | 806-745-5413
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Fax | 806-745-5580
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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