1023299393 NPI number — DR. CARLOS ALFONSO QUILALA SANTOS MD

Table of content: DR. CARLOS ALFONSO QUILALA SANTOS MD (NPI 1023299393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023299393 NPI number — DR. CARLOS ALFONSO QUILALA SANTOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTOS
Provider First Name:
CARLOS
Provider Middle Name:
ALFONSO QUILALA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1023299393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 S EUCLID AVE
Provider Second Line Business Mailing Address:
C B 8051
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63110-1010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-996-3281
Provider Business Mailing Address Fax Number:
314-996-3195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 BARNES WEST DR
Provider Second Line Business Practice Location Address:
POB 2 STE 200
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-6350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-747-2066
Provider Business Practice Location Address Fax Number:
314-747-1277
Provider Enumeration Date:
11/15/2007

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: 207RI0200X , with the licence number:  2009001296 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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