Provider Demographics
NPI:1427700566
Name:SANTOS, JUSTIN JAMES
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JAMES
Last Name:SANTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14429 LACOTA POINT DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2503
Mailing Address - Country:US
Mailing Address - Phone:915-401-4377
Mailing Address - Fax:
Practice Address - Street 1:14429 LACOTA POINT DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2503
Practice Address - Country:US
Practice Address - Phone:915-401-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLHCOC21-000533747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant