1023158722 NPI number — DR. EDELYN MANUEL SANTOS DDS

Table of content: DR. EDELYN MANUEL SANTOS DDS (NPI 1023158722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023158722 NPI number — DR. EDELYN MANUEL SANTOS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTOS
Provider First Name:
EDELYN
Provider Middle Name:
MANUEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023158722
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4287 GEORGE AVE
Provider Second Line Business Mailing Address:
#2
Provider Business Mailing Address City Name:
SAN MATEO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94403-4698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-867-2128
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33341 ALVARADO NILES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94587-3195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-471-9300
Provider Business Practice Location Address Fax Number:
510-471-9300
Provider Enumeration Date:
02/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  46628 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)