Provider Demographics
NPI:1376508101
Name:SANTOS, JUAN FELIPE (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:FELIPE
Last Name:SANTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 GORDON ST STE B
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2517
Mailing Address - Country:US
Mailing Address - Phone:361-882-9100
Mailing Address - Fax:361-882-9194
Practice Address - Street 1:527 GORDON ST STE B
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2517
Practice Address - Country:US
Practice Address - Phone:361-882-9100
Practice Address - Fax:361-882-9194
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH27542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098555804Medicaid
TX098555804Medicaid
TXE52027Medicare UPIN