Provider Demographics
NPI:1992224547
Name:MASTORIS, SANTINA ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:SANTINA
Middle Name:ELIZABETH
Last Name:MASTORIS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 SAN GABRIEL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3548
Mailing Address - Country:US
Mailing Address - Phone:512-815-0123
Mailing Address - Fax:512-861-6206
Practice Address - Street 1:2905 SAN GABRIEL ST STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3548
Practice Address - Country:US
Practice Address - Phone:512-815-0123
Practice Address - Fax:512-861-6206
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021286363AS0400X
NY21286363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty