Provider Demographics
NPI:1720801194
Name:DELOS SANTOS, ANNYKA
Entity type:Individual
Prefix:
First Name:ANNYKA
Middle Name:
Last Name:DELOS SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11527 VALLEY PIKE CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-0902
Mailing Address - Country:US
Mailing Address - Phone:713-282-1611
Mailing Address - Fax:
Practice Address - Street 1:11527 VALLEY PIKE CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-0902
Practice Address - Country:US
Practice Address - Phone:713-282-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1178165363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily