Provider Demographics
NPI:1629257191
Name:EDUARDO SANTOS UY MD INC
Entity Type:Organization
Organization Name:EDUARDO SANTOS UY MD INC
Other - Org Name:SAN SEBASTIAN FAMILY MEDICAL GROUP, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:SANTOS
Authorized Official - Last Name:UY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-886-8888
Mailing Address - Street 1:9717 SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6716
Mailing Address - Country:US
Mailing Address - Phone:909-822-3400
Mailing Address - Fax:909-886-8881
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:909-886-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A530160Medicaid
CA00A530160Medicaid
CA=========OtherTAX ID NUMBER
CAZZZ28808ZMedicare PIN