Provider Demographics
NPI:1295073955
Name:SANTOS, ADELA R (PMHNP)
Entity type:Individual
Prefix:
First Name:ADELA
Middle Name:R
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 MERRILL DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78408-3344
Mailing Address - Country:US
Mailing Address - Phone:361-765-4666
Mailing Address - Fax:800-854-6952
Practice Address - Street 1:6625 WOOLDRIDGE RD STE 402
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2916
Practice Address - Country:US
Practice Address - Phone:361-765-4666
Practice Address - Fax:800-854-6952
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122367363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP122367OtherAPRN LICENSE
TX333733901Medicaid
TX337208YTERMedicare PIN