1528343944 NPI number — DR. DOUGLAS RICHARD SANTILLO DPHYT

Table of content: DR. DOUGLAS RICHARD SANTILLO DPHYT (NPI 1528343944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528343944 NPI number — DR. DOUGLAS RICHARD SANTILLO DPHYT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTILLO
Provider First Name:
DOUGLAS
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPHYT
Provider Gender Code:
M

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:
1528343944
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BOX 357051
Provider Second Line Business Mailing Address:
CMDR NAVAL AF, FORCE HLTH SRVCS N01H NASNI
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92135-7051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-545-1148
Provider Business Mailing Address Fax Number:
619-767-7417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N01H FORCE HEALTH SERVICES
Provider Second Line Business Practice Location Address:
NASNI
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92135-7051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-545-1148
Provider Business Practice Location Address Fax Number:
619-767-7417
Provider Enumeration Date:
10/17/2011

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: 225100000X , with the licence number:  PTL-11462 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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