Provider Demographics
NPI:1538337944
Name:RUBEN DE LOS SANTOS MD PA
Entity type:Organization
Organization Name:RUBEN DE LOS SANTOS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LOS SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-773-7474
Mailing Address - Street 1:1955 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4714
Mailing Address - Country:US
Mailing Address - Phone:830-773-7474
Mailing Address - Fax:830-872-2659
Practice Address - Street 1:1955 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4714
Practice Address - Country:US
Practice Address - Phone:830-773-7474
Practice Address - Fax:830-872-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127850904Medicaid
TXC18903Medicare UPIN
TX127850904Medicaid