1568792737 NPI number — CARLOS R SANTOS MD PA

Table of content: (NPI 1568792737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568792737 NPI number — CARLOS R SANTOS MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARLOS R SANTOS MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1568792737
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 198704
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-8704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-653-0425
Provider Business Mailing Address Fax Number:
305-653-4055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3164 S UNIVERSITY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIRAMAR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33025-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-849-0621
Provider Business Practice Location Address Fax Number:
305-653-4055
Provider Enumeration Date:
01/11/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SANTOS
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-653-0425

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  ME81286 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 265324900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".