MEDICARE: RAVENAL SANTOS JR. RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WN0300X	Nephrology Registered Nurse	495467	CA

General Provider Information

NPI Number	:	1093549842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVENAL SANTOS JR. RN

Provider Business Mailing Address
First Line	:	393 BLOSSOM HILL RD STE 110
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-1653
Country	:	US
Telephone Number	:	408-629-9802
Fax Number	:	408-629-9808

Provider Business Practice Location Address
First Line	:	393 BLOSSOM HILL RD STE 110
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-1653
Country	:	US
Telephone Number	:	408-629-9802
Fax Number	:	408-629-9808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	08/26/2024

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