Provider Demographics
NPI:1386656114
Name:SANTOS, JOEY ARCADIO L (MD)
Entity type:Individual
Prefix:
First Name:JOEY
Middle Name:ARCADIO L
Last Name:SANTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28237
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92809-0141
Mailing Address - Country:US
Mailing Address - Phone:714-635-7127
Mailing Address - Fax:
Practice Address - Street 1:1020 S ANAHEIM BLVD
Practice Address - Street 2:STE 220
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5851
Practice Address - Country:US
Practice Address - Phone:714-635-7127
Practice Address - Fax:714-772-3521
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C03982Medicare UPIN