MEDICARE: J SANTANA INC

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	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1831655539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J SANTANA INC

Provider Business Mailing Address
First Line	:	5600 MOUNT STORM WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-4437
Country	:	US
Telephone Number	:	817-716-4754
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 MOUNT STORM WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-4437
Country	:	US
Telephone Number	:	817-716-4754
Fax Number	:

Authorized Official
Title or Position	:	SURGICAL ASSISTANT
Name	:	JOSE SANTANA JR.
Credential	:	CSFA
Telephone Number	:	817-716-4754

Provider Enumeration Date	:	02/18/2019
Last Update Date	:	02/18/2019

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