Provider Demographics
NPI:1710116686
Name:SANTOS, ELMER D (NP)
Entity Type:Individual
Prefix:MR
First Name:ELMER
Middle Name:D
Last Name:SANTOS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-5161
Mailing Address - Country:US
Mailing Address - Phone:209-826-6785
Mailing Address - Fax:
Practice Address - Street 1:776 BLUFF DR
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-5161
Practice Address - Country:US
Practice Address - Phone:209-826-6785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA364792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily