Healthcare Provider Details

I. General information

NPI: 1801753264
Provider Name (Legal Business Name): CEDRIC ALEN SANTOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S 7TH AVE STE 150
PHOENIX AZ
85007-4075
US

IV. Provider business mailing address

1205 S 7TH AVE STE 105
PHOENIX AZ
85007-3913
US

V. Phone/Fax

Practice location:
  • Phone: 602-416-7600
  • Fax: 602-253-5120
Mailing address:
  • Phone: 602-416-7600
  • Fax: 602-253-5120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: