Provider Demographics
NPI:1831655539
Name:J SANTANA INC
Entity Type:Organization
Organization Name:J SANTANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:JR
Authorized Official - Credentials:CSFA
Authorized Official - Phone:817-716-4754
Mailing Address - Street 1:5600 MOUNT STORM WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-4437
Mailing Address - Country:US
Mailing Address - Phone:817-716-4754
Mailing Address - Fax:
Practice Address - Street 1:5600 MOUNT STORM WAY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-4437
Practice Address - Country:US
Practice Address - Phone:817-716-4754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty