Provider Demographics
NPI:1154409324
Name:DE LOS SANTOS, EDDY (MD)
Entity type:Individual
Prefix:
First Name:EDDY
Middle Name:
Last Name:DE LOS SANTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:618S MADISON DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-7248
Mailing Address - Country:US
Mailing Address - Phone:480-784-1514
Mailing Address - Fax:480-736-4939
Practice Address - Street 1:1540W VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-2414
Practice Address - Country:US
Practice Address - Phone:480-784-1514
Practice Address - Fax:480-736-4939
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ334742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ947898Medicaid
AZ134202Medicare UPIN
AZ947898Medicaid