Provider Demographics
NPI:1528043783
Name:SANTOS PICO, JOSE V (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:V
Last Name:SANTOS PICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4351 E LOHMAN AVE STE 409
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8263
Mailing Address - Country:US
Mailing Address - Phone:575-522-4433
Mailing Address - Fax:575-522-4950
Practice Address - Street 1:4351 E LOHMAN AVE STE 409
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8263
Practice Address - Country:US
Practice Address - Phone:575-522-4433
Practice Address - Fax:575-522-4950
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2015-0001207T00000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM30327814Medicaid
NM405577YY54Medicare PIN