MEDICARE: GINA THERESA DESANTO MD

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	207R00000X	Internal Medicine Physician	2023-03172	NC
2	207R00000X	Internal Medicine Physician	35C.000862	OH
3	207R00000X	Internal Medicine Physician	K2680	TX
4	207R00000X	Internal Medicine Physician	328122	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871656298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA THERESA DESANTO MD

Provider Business Mailing Address
First Line	:	8911 N CAPITAL OF TEXAS HWY STE 1110
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-7203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8911 N CAPITAL OF TEXAS HWY STE 1110
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-7203
Country	:	US
Telephone Number	:	737-226-6700
Fax Number	:

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	09/24/2025

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Directions to “ GINA THERESA DESANTO MD” Practice Location

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