Provider Demographics
NPI:1275168007
Name:SANTILLAN, HECTOR JR
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:SANTILLAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 CRAVEN ST NAVAL STATION SAN DIEGO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92136-0001
Mailing Address - Country:US
Mailing Address - Phone:619-556-8101
Mailing Address - Fax:619-556-9869
Practice Address - Street 1:2450 CRAVEN ST NAVAL STATION SAN DIEGO
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-0001
Practice Address - Country:US
Practice Address - Phone:619-556-8101
Practice Address - Fax:619-556-9869
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman