Provider Demographics
NPI:1265547608
Name:SANTOS, PACIFICO C (MD)
Entity type:Individual
Prefix:
First Name:PACIFICO
Middle Name:C
Last Name:SANTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:200 N JACKSON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1601
Mailing Address - Country:US
Mailing Address - Phone:408-251-4240
Mailing Address - Fax:408-251-7859
Practice Address - Street 1:200 N JACKSON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1601
Practice Address - Country:US
Practice Address - Phone:408-251-4240
Practice Address - Fax:408-251-7859
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA29516207Q00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25795Medicare UPIN
CAA295163Medicare ID - Type Unspecified