Provider Demographics
NPI:1740290899
Name:UY, SANTOS A JR (MD)
Entity type:Individual
Prefix:
First Name:SANTOS
Middle Name:A
Last Name:UY
Suffix:JR
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 1:201 S ALVARADO ST
Mailing Address - Street 2:SUITE 811
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2320
Mailing Address - Country:US
Mailing Address - Phone:213-484-1005
Mailing Address - Fax:213-484-2053
Practice Address - Street 1:201 S ALVARADO ST
Practice Address - Street 2:SUITE 811
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2320
Practice Address - Country:US
Practice Address - Phone:213-484-1005
Practice Address - Fax:213-484-2053
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32697207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A32697Medicaid
CA00A32697Medicaid
A26898Medicare UPIN