Provider Demographics
NPI:1730111071
Name:DE LOS SANTOS, LAURA A (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:DE LOS SANTOS
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 1:7950 FLOYD CURL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3919
Mailing Address - Country:US
Mailing Address - Phone:210-615-6505
Mailing Address - Fax:210-615-1321
Practice Address - Street 1:7950 FLOYD CURL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3919
Practice Address - Country:US
Practice Address - Phone:210-615-6505
Practice Address - Fax:210-615-1321
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8512207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G4694OtherBC/BS
TX181355201Medicaid
TX8G4694OtherBC/BS
TX181355201Medicaid