Provider Demographics
NPI:1407164536
Name:SANTOS, SELINA DIANE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SELINA
Middle Name:DIANE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2611 SAINT ANTHONY ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1722
Mailing Address - Country:US
Mailing Address - Phone:832-971-1853
Mailing Address - Fax:
Practice Address - Street 1:3705 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1019
Practice Address - Country:US
Practice Address - Phone:512-454-3781
Practice Address - Fax:512-454-4058
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2013-04-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant