Provider Demographics
NPI:1467460832
Name:SANTIANO, FLORDELYS CASTRO-SANTILLAN (MD)
Entity Type:Individual
Prefix:
First Name:FLORDELYS
Middle Name:CASTRO-SANTILLAN
Last Name:SANTIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FLORDELYS
Other - Middle Name:CASTRO
Other - Last Name:SANTILLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1319 NE 134TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2718
Mailing Address - Country:US
Mailing Address - Phone:360-566-4726
Mailing Address - Fax:360-576-9925
Practice Address - Street 1:1319 NE 134TH ST STE 107
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2718
Practice Address - Country:US
Practice Address - Phone:360-566-4726
Practice Address - Fax:360-576-9925
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033875174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8194722Medicaid
WAAB24530Medicare PIN
WAAB24529Medicare PIN
WAG11194Medicare UPIN
WAGAB24530Medicare PIN