1013149533 NPI number — CRISTINA SANTOS CANDIDO-VITTO MD

Table of content: CRISTINA SANTOS CANDIDO-VITTO MD (NPI 1013149533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013149533 NPI number — CRISTINA SANTOS CANDIDO-VITTO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANDIDO-VITTO
Provider First Name:
CRISTINA
Provider Middle Name:
SANTOS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CANDIDO
Provider Other First Name:
CRISTINA
Provider Other Middle Name:
SANTOS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013149533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 ALISAL RD
Provider Second Line Business Mailing Address:
UNIT 2
Provider Business Mailing Address City Name:
SOLVANG
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93463-3704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-330-3788
Provider Business Mailing Address Fax Number:
702-837-8825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
427 W PUEBLO ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93105-6206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-569-7850
Provider Business Practice Location Address Fax Number:
805-682-1618
Provider Enumeration Date:
08/17/2009

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: 2080P0205X , with the licence number:  A108448 , 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)





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