Provider Demographics
NPI:1558688325
Name:DESANTIAGO, ELDA ANTONIA
Entity Type:Individual
Prefix:MRS
First Name:ELDA
Middle Name:ANTONIA
Last Name:DESANTIAGO
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 1:2526 82ND ST
Mailing Address - Street 2:STE B
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2223
Mailing Address - Country:US
Mailing Address - Phone:806-745-5413
Mailing Address - Fax:806-745-5580
Practice Address - Street 1:2526 82ND ST
Practice Address - Street 2:STE B
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2223
Practice Address - Country:US
Practice Address - Phone:806-745-5413
Practice Address - Fax:806-745-5580
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health