Provider Demographics
NPI:1548794944
Name:SANTOS, ELSIE SEGUIN
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:SEGUIN
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 WHITE OAK CT
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1703
Mailing Address - Country:US
Mailing Address - Phone:619-201-6231
Mailing Address - Fax:
Practice Address - Street 1:1182 WHITE OAK CT
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1703
Practice Address - Country:US
Practice Address - Phone:619-201-6231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA850243163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse