Individual
DR. IVELISSE SANTIAGO-BAROUHAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1102 W TRENTON RD, EDINBURG, TX 78539-9105
(956) 388-6000
(956) 289-2956
Mailing address
PO BOX 3046, MALVERN, PA 19355-0746
(956) 388-6000
(956) 289-2956
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
G9042
TX
208M00000X
Hospitalist Physician
Primary
G9042
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135088604
—
TX
05
—
135088608
—
TX
05
—
135088609
—
TX
05
—
135088610
—
TX
01
—
1F7941
MEDICARE PTAN
TX
Enumeration date
05/16/2007
Last updated
11/12/2020
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