1275044786 NPI number — MR. ROMULUS ANICETE SANTOS PT

Table of content: MR. ROMULUS ANICETE SANTOS PT (NPI 1275044786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275044786 NPI number — MR. ROMULUS ANICETE SANTOS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTOS
Provider First Name:
ROMULUS
Provider Middle Name:
ANICETE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275044786
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 777851
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89077-7851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-893-3333
Provider Business Mailing Address Fax Number:
702-413-7775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6462 LOSEE RD.
Provider Second Line Business Practice Location Address:
STE. 135
Provider Business Practice Location Address City Name:
N LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-625-4809
Provider Business Practice Location Address Fax Number:
702-462-5218
Provider Enumeration Date:
10/24/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  25843 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 3937 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)