Individual
SANTOSA HO
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1602 4TH STREET, MARYSVILLE, WA 98270-5014
(360) 659-4141
(360) 659-1712
Mailing address
1602 4TH STREET, MARYSVILLE, WA 98270-5014
(360) 659-4141
(360) 659-1712
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00032254
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1091917
—
WA
01
—
81109
L & I
—
Enumeration date
04/26/2006
Last updated
07/08/2007
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