Provider Demographics
NPI:1417134867
Name:DE LOS SANTOS, HUMBERTO ANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:ANGEL
Last Name:DE LOS SANTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1411 N BECKLEY AVE
Mailing Address - Street 2:SUITE 356
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1591
Mailing Address - Country:US
Mailing Address - Phone:214-941-0100
Mailing Address - Fax:214-941-7024
Practice Address - Street 1:1411 N BECKLEY AVE
Practice Address - Street 2:SUITE 356
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1591
Practice Address - Country:US
Practice Address - Phone:214-941-0100
Practice Address - Fax:214-941-7024
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX N7247207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217656201Medicaid
TX217656201Medicaid