Provider Demographics
NPI:1619967007
Name:SANTILLANO, EUGENE C (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:C
Last Name:SANTILLANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 SCOTTS VALLEY DR STE B
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-3465
Mailing Address - Country:US
Mailing Address - Phone:408-337-6383
Mailing Address - Fax:
Practice Address - Street 1:5610 SCOTTS VALLEY DR
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-3473
Practice Address - Country:US
Practice Address - Phone:408-337-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88670207Q00000X, 207QA0401X
PAMD428878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101722200Medicaid
I57272Medicare UPIN
PA101722200Medicaid