Provider Demographics
NPI:1053535310
Name:YCO, MARIO SANTOS (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:SANTOS
Last Name:YCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6399 SAN IGNACIO AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1215
Mailing Address - Country:US
Mailing Address - Phone:408-369-5620
Mailing Address - Fax:408-904-7730
Practice Address - Street 1:477 N EL CAMINO REAL
Practice Address - Street 2:SUITE A-210
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1328
Practice Address - Country:US
Practice Address - Phone:760-944-4211
Practice Address - Fax:760-944-9769
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42612207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G426121Medicaid
CAC68050Medicare UPIN
CAG42612AMedicare ID - Type Unspecified