Provider Demographics
NPI:1881722262
Name:SANTOS, LUZ MARIA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:MARIA
Last Name:SANTOS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9902 MCPHERSON RD
Mailing Address - Street 2:STE #1
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6545
Mailing Address - Country:US
Mailing Address - Phone:956-795-8510
Mailing Address - Fax:956-795-8513
Practice Address - Street 1:9902 MCPHERSON RD
Practice Address - Street 2:STE #1
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-795-8510
Practice Address - Fax:956-795-8513
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX555606164W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178651901Medicaid
TX178651901Medicaid