Provider Demographics
NPI:1255660916
Name:SANTOS, BRENDA ELAINE (PA)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:ELAINE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12952 BANDERA RD STE 105
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4690
Mailing Address - Country:US
Mailing Address - Phone:210-695-1900
Mailing Address - Fax:
Practice Address - Street 1:12952 BANDERA RD STE 105
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4690
Practice Address - Country:US
Practice Address - Phone:210-695-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285710401Medicaid
TX285710401Medicaid