Provider Demographics
NPI:1386109791
Name:JOHN, SANIL (SA-C)
Entity type:Individual
Prefix:DR
First Name:SANIL
Middle Name:
Last Name:JOHN
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13232 VISTA GLEN LN
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-7273
Mailing Address - Country:US
Mailing Address - Phone:817-703-1284
Mailing Address - Fax:
Practice Address - Street 1:SOUTH TEXAS BRAIN AND SPINE CENTERS, 1227 3RD ST,
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404
Practice Address - Country:US
Practice Address - Phone:361-883-4323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant