Provider Demographics
NPI:1497360846
Name:SANTOS, JUAN CARLOS (FNP-C)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:SANTOS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 KIRBY DR STE 1200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3985
Mailing Address - Country:US
Mailing Address - Phone:281-888-8999
Mailing Address - Fax:281-305-4054
Practice Address - Street 1:6419 POLARIS DR # B2
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-7804
Practice Address - Country:US
Practice Address - Phone:281-888-8999
Practice Address - Fax:281-305-4054
Is Sole Proprietor?:No
Enumeration Date:2020-09-12
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142859363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily