Provider Demographics
NPI:1124618186
Name:SANTOS, CRISTHIAM ALFREDO (PA-C)
Entity type:Individual
Prefix:
First Name:CRISTHIAM
Middle Name:ALFREDO
Last Name:SANTOS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10437 LA REINA AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-2562
Mailing Address - Country:US
Mailing Address - Phone:562-392-2253
Mailing Address - Fax:
Practice Address - Street 1:10437 LA REINA AVE APT 201
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2562
Practice Address - Country:US
Practice Address - Phone:562-392-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant