NPIMap

Organization Active NPI

Ricardo de Los Santos, M.D.,P.a.

Doing business as Pediatric Specialty Clinic & Lab #2

  • Pediatrics Physician
  • Eagle Pass, TX
National Provider Identifier
1619091295
Registry record updated Nov 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
F3442 Issued in TX
Legal business name
RICARDO DE LOS SANTOS, M.D.,P.A.
Doing business as
Pediatric Specialty Clinic & Lab #2
Practice address
2198 E. Garrison St.
Ste. 1
Eagle Pass, TX 78852-5076
Phone
(830) 773-1103
Fax
(830) 757-8366
NPI assigned
Mar 19, 2007
Last updated
Nov 16, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Debra W. De Los Santos
Title
Ceo
Phone
(830) 773-1103

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X F3442 TX Primary
Clinical Medical Laboratory 291U00000X 45D0506351 TX

Addresses

Primary practice location

2198 E. Garrison St.
Ste. 1
Eagle Pass, TX 78852-5076

Mailing address

2198 E. Garrison St.
Ste. 1
Eagle Pass, TX 78852-5076
Phone (830) 773-1103

Other identifiers 2

IdentifierTypeStateIssuer
111923201MedicaidTX
363381001MedicaidTX

Other names 1

  • Pediatric Specialty Clinic & Lab #2 Doing business as

National Provider Directory

National Provider Directory

Locations

2198 E Garrison St
Ste 1
Eagle Pass, TX 78852
Phone (830) 773-1103

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479254400000",
    "number": "1619091295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2198 E. GARRISON ST.",
            "address_2": "STE. 1",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788525076",
            "telephone_number": "830-773-1103",
            "fax_number": "830-757-8366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2198 E. GARRISON ST.",
            "address_2": "STE. 1",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788525076",
            "telephone_number": "830-773-1103",
            "fax_number": "830-757-8366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICARDO DE LOS SANTOS, M.D.,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2016-11-16",
        "status": "A",
        "authorized_official_last_name": "DE LOS SANTOS",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "830-773-1103",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "F3442",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TX",
            "license": "45D0506351",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111923201",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "363381001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Specialty Clinic & Lab #2",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eagle Pass, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.