Basic Information
| Provider Information | |||||||||
| NPI: | 1376840546 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANTE HEALTH FOUNDATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 28949 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937298949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592285400 | ||||||||
| FaxNumber: | 5592241825 | ||||||||
| Practice Location | |||||||||
| Address1: | 1180 E SHAW AVE | ||||||||
| Address2: | SUITE 222 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937107812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592285400 | ||||||||
| FaxNumber: | 5592241825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2011 | ||||||||
| LastUpdateDate: | 02/23/2011 | ||||||||
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| AuthorizedOfficialLastName: | DESOTO | ||||||||
| AuthorizedOfficialFirstName: | MATEO | ||||||||
| AuthorizedOfficialMiddleName: | F. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5592285400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.