Provider Demographics
NPI:1881992097
Name:SANTANA, JOSE JR (CST)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:SANTANA
Suffix:JR
Gender:M
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10317 DALLAM LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-4975
Mailing Address - Country:US
Mailing Address - Phone:817-244-3511
Mailing Address - Fax:
Practice Address - Street 1:10317 DALLAM LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-4975
Practice Address - Country:US
Practice Address - Phone:817-244-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84215246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other