Provider Demographics
NPI:1265651608
Name:SANTANIELLO ORTHOPAEDIC MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SANTANIELLO ORTHOPAEDIC MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANTANIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-982-4233
Mailing Address - Street 1:1238 E. ARROW HWY.
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4910
Mailing Address - Country:US
Mailing Address - Phone:909-982-4233
Mailing Address - Fax:909-985-1103
Practice Address - Street 1:1238 E ARROW HWY
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4951
Practice Address - Country:US
Practice Address - Phone:909-982-4233
Practice Address - Fax:909-985-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21403174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG214030OtherLICENSE
CA00G214031OtherMEDICARE INDIVIDUAL PTAN
CA1265651608OtherSANTANIELLO ORTHO (NPI)
CA1124120696OtherJOHN SANTANIELLO (NPI)
CA1265651608OtherSANTANIELLO ORTHO (NPI)
CAG214030OtherLICENSE