Provider Demographics
NPI:1578097978
Name:SANTANDER, ISRAEL (DPM)
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:SANTANDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S BUENA VISTA ST STE 305
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4516
Mailing Address - Country:US
Mailing Address - Phone:818-848-5588
Mailing Address - Fax:
Practice Address - Street 1:201 S BUENA VISTA ST STE 305
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4516
Practice Address - Country:US
Practice Address - Phone:818-848-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301301213ES0103X
390200000X
CA5672213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty