Basic Information
| Provider Information | |||||||||
| NPI: | 1760034706 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EPSTEIN-SANTOYO | ||||||||
| FirstName: | JENNAH | ||||||||
| MiddleName: | BUCKAROO | ||||||||
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| OtherLastName: | EPSTEINKRAUS | ||||||||
| OtherFirstName: | JENNAH | ||||||||
| OtherMiddleName: | BUCKAROO | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 93 CHILTON ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021386844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175496081 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1493 CAMBRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021391047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176651000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2019 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0200X | RN2283367 | MA | Y | Nursing Service Providers | Registered Nurse | Pediatrics |
No ID Information.