Provider Demographics
NPI:1003985565
Name:SANTILLAN, JOAQUIN F (MPT)
Entity Type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:F
Last Name:SANTILLAN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 N MESA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5919
Mailing Address - Country:US
Mailing Address - Phone:915-351-6600
Mailing Address - Fax:
Practice Address - Street 1:103 LIVINGSTON LOOP
Practice Address - Street 2:SUITE B1
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9747
Practice Address - Country:US
Practice Address - Phone:575-587-7061
Practice Address - Fax:915-493-8264
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1104438225100000X
NM4955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM550248YR5RMedicare PIN