Provider Demographics
NPI:1578613949
Name:UY, EDUARDO SANTOS (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:SANTOS
Last Name:UY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 BELMONT CT
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7180
Mailing Address - Country:US
Mailing Address - Phone:909-307-7978
Mailing Address - Fax:909-822-2308
Practice Address - Street 1:9717 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6716
Practice Address - Country:US
Practice Address - Phone:909-822-3400
Practice Address - Fax:909-822-2308
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA053016208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A530160Medicaid
CAZZZ28808ZMedicare PIN
CAY02400Medicare UPIN