Provider Demographics
NPI:1609979665
Name:SANTORA, MARION Z (MD)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:Z
Last Name:SANTORA
Suffix:
Gender:F
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:P.O. BOX 56
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95001
Mailing Address - Country:US
Mailing Address - Phone:831-457-7038
Mailing Address - Fax:831-457-7195
Practice Address - Street 1:1555 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1705
Practice Address - Country:US
Practice Address - Phone:831-457-7038
Practice Address - Fax:831-457-7195
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28088208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G280880OtherMEDI-CAL NUMBER
CA00G280880OtherMEDI-CAL NUMBER