Basic Information
| Provider Information | |||||||||
| NPI: | 1003985565 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SANTILLAN | ||||||||
| FirstName: | JOAQUIN | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4849 N MESA ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799125919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9153516600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 103 LIVINGSTON LOOP | ||||||||
| Address2: | SUITE B1 | ||||||||
| City: | SANTA TERESA | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880089747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755877061 | ||||||||
| FaxNumber: | 9154938264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 01/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1104438 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 4955 | NM | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.