Provider Demographics
NPI:1982469060
Name:RUSSIAN, SANTOS MICHAEL
Entity Type:Individual
Prefix:
First Name:SANTOS
Middle Name:MICHAEL
Last Name:RUSSIAN
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 1:157 S K ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-4011
Mailing Address - Country:US
Mailing Address - Phone:661-609-2128
Mailing Address - Fax:
Practice Address - Street 1:157 S K ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4011
Practice Address - Country:US
Practice Address - Phone:661-609-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide