Provider Demographics
NPI:1437304854
Name:SANTANA, PEPE S (PHD)
Entity Type:Individual
Prefix:DR
First Name:PEPE
Middle Name:S
Last Name:SANTANA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 S JACKSON ST STE 204
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3803
Mailing Address - Country:US
Mailing Address - Phone:720-272-0565
Mailing Address - Fax:720-368-5256
Practice Address - Street 1:1776 S JACKSON ST STE 204
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210
Practice Address - Country:US
Practice Address - Phone:720-272-0565
Practice Address - Fax:720-368-5256
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3265103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38358255Medicaid
COCOB4300Medicare PIN