Basic Information
| Provider Information | |||||||||
| NPI: | 1295073955 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANTOS | ||||||||
| FirstName: | ADELA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2726 HIGHWAY 35 N | ||||||||
| Address2: | |||||||||
| City: | ROCKPORT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 783825709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618345300 | ||||||||
| FaxNumber: | 3617272036 | ||||||||
| Practice Location | |||||||||
| Address1: | 2726 HIGHWAY 35 N | ||||||||
| Address2: | |||||||||
| City: | ROCKPORT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 783825709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3617295357 | ||||||||
| FaxNumber: | 3617272036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2013 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP122367 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0808X | AP122367 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | AP122367 | 01 | TX | APRN LICENSE | OTHER |