Provider Demographics
NPI:1649478884
Name:RAUL SANTA-ANA MD PA
Entity type:Organization
Organization Name:RAUL SANTA-ANA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:BALLI
Authorized Official - Last Name:SANTA-ANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-581-2700
Mailing Address - Street 1:1928 N CONWAY AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2945
Mailing Address - Country:US
Mailing Address - Phone:956-581-2700
Mailing Address - Fax:956-581-1331
Practice Address - Street 1:1928 N CONWAY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2945
Practice Address - Country:US
Practice Address - Phone:956-581-2700
Practice Address - Fax:956-581-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0106208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089761301Medicaid
TXC21557Medicare UPIN
TX00DW10Medicare PIN