Provider Demographics
NPI:1376631176
Name:SANTESTEBAN, ALFREDO O (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:O
Last Name:SANTESTEBAN
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 1:1200 WINNIPEG DR
Mailing Address - Street 2:REVENUE MANAGEMENT
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2978
Mailing Address - Country:US
Mailing Address - Phone:469-464-3150
Mailing Address - Fax:
Practice Address - Street 1:1200 WINNIPEG DR
Practice Address - Street 2:REVENUE MANAGEMENT
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2978
Practice Address - Country:US
Practice Address - Phone:469-464-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5429208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0885094OtherCIGNA PIN
TX88097OtherUHC PIN
TX82Y920OtherBCBSTX IND PIN
TX140442820Medicaid
073065OtherECFMG
TX123586301Medicaid
1750369203OtherGRP NPI NUMBER
TX4396098OtherAETNA PIN
TX00U87ZOtherBCBSTX GRP PIN
TX12353100OtherFIRSTCARE PIN
TX733833OtherFIRSTHEALTH PIN
TXSANAB26165OtherCCHIP PIN
TXSANAB26165OtherCCHIP PIN
TX12353100OtherFIRSTCARE PIN
B26165Medicare UPIN