MEDICARE: JOSE SANTANA JR. CST

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	246Z00000X	Other Specialist/Technologist	84215	TX

General Provider Information

NPI Number	:	1881992097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE SANTANA JR. CST

Provider Business Mailing Address
First Line	:	10317 DALLAM LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-4975
Country	:	US
Telephone Number	:	817-244-3511
Fax Number	:

Provider Business Practice Location Address
First Line	:	10317 DALLAM LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-4975
Country	:	US
Telephone Number	:	817-244-3511
Fax Number	:

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

Provider Enumeration Date	:	03/11/2011
Last Update Date	:	03/11/2011

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Directions to “ JOSE SANTANA JR. CST” Practice Location

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