Provider Demographics
NPI:1093549842
Name:SANTOS, RAVENAL JR (RN)
Entity type:Individual
Prefix:
First Name:RAVENAL
Middle Name:
Last Name:SANTOS
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 BLOSSOM HILL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1653
Mailing Address - Country:US
Mailing Address - Phone:408-629-9802
Mailing Address - Fax:408-629-9808
Practice Address - Street 1:393 BLOSSOM HILL RD STE 110
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1653
Practice Address - Country:US
Practice Address - Phone:408-629-9802
Practice Address - Fax:408-629-9808
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495467163WN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0300XNursing Service ProvidersRegistered NurseNephrology