Provider Demographics
NPI:1003547266
Name:DE LOS SANTOS, ALEXIS I
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:DE LOS SANTOS
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 N BARTON ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-2516
Mailing Address - Country:US
Mailing Address - Phone:254-434-3472
Mailing Address - Fax:
Practice Address - Street 1:1490 N BARTON ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-2516
Practice Address - Country:US
Practice Address - Phone:254-434-3472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program