Basic Information
| Provider Information | |||||||||
| NPI: | 1891304408 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADELA R. SANTOS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 353 MERRILL DR | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784083344 | ||||||||
| 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: | 07/29/2020 | ||||||||
| LastUpdateDate: | 07/29/2020 | ||||||||
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| AuthorizedOfficialLastName: | SANTOS | ||||||||
| AuthorizedOfficialFirstName: | ADELA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHIATRIC NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 3618345300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MSN, APRN, PMHNP-BC | ||||||||
| NPICertificationDate: | 07/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 12667258 | 01 | TX | CAQH | OTHER |