Provider Demographics
NPI:1871656298
Name:DESANTO, GINA THERESA (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:THERESA
Last Name:DESANTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:T
Other - Last Name:DESANTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8911 N CAPITAL OF TEXAS HWY STE 1110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8911 N CAPITAL OF TEXAS HWY STE 1110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7203
Practice Address - Country:US
Practice Address - Phone:737-226-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-03172207R00000X
TXK2680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046295408Medicaid
TX046295403Medicaid
TX046295408Medicaid
TX046295403Medicaid
TXG76333Medicare UPIN