Provider Demographics
NPI:1790518405
Name:BARRERA, SANTANA
Entity type:Individual
Prefix:
First Name:SANTANA
Middle Name:
Last Name:BARRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22907 BANFF BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-1420
Mailing Address - Country:US
Mailing Address - Phone:956-240-4563
Mailing Address - Fax:
Practice Address - Street 1:142 1ST ST W
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3619
Practice Address - Country:US
Practice Address - Phone:832-644-1565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor