Provider Demographics
NPI:1720162563
Name:EDWARD J. SANTORO MD., INC.
Entity Type:Organization
Organization Name:EDWARD J. SANTORO MD., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANTORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-237-1580
Mailing Address - Street 1:703 N FULTON ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-3405
Mailing Address - Country:US
Mailing Address - Phone:559-237-1580
Mailing Address - Fax:559-233-3381
Practice Address - Street 1:703 N FULTON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-3405
Practice Address - Country:US
Practice Address - Phone:559-237-1580
Practice Address - Fax:559-233-3381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21184261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A211840Medicaid
CA00A211840Medicare ID - Type Unspecified
CA00A211840Medicaid