Basic Information
| Provider Information | |||||||||
| NPI: | 1558527846 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE LOS SANTOS | ||||||||
| FirstName: | ALEJANDRO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1169 | ||||||||
| Address2: | |||||||||
| City: | SAN GERMAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006831169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875382306 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 E DAWSON ST | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757012036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036064129 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2008 | ||||||||
| LastUpdateDate: | 01/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 00000 | PR | N | Allopathic & Osteopathic Physicians | General Practice | 208M00000X | P4300 | TX | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | P01105290 | 01 | TX | MEDICARE RAIL ROAD | OTHER |