Provider Demographics
NPI:1346908209
Name:DOS SANTOS, THIAGO (PA)
Entity Type:Individual
Prefix:
First Name:THIAGO
Middle Name:
Last Name:DOS SANTOS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 SUMMIT CRST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-1932
Mailing Address - Country:US
Mailing Address - Phone:626-782-8255
Mailing Address - Fax:
Practice Address - Street 1:5673 GLORIETA PASS RD APT D
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79906-2134
Practice Address - Country:US
Practice Address - Phone:626-782-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant