Healthcare Provider Details

I. General information

NPI: 1053847772
Provider Name (Legal Business Name): GWENN SANTORO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 W ORANGE GROVE RD STE 302
TUCSON AZ
85704-1152
US

IV. Provider business mailing address

219 ANDERSON PL
BUFFALO NY
14222-1803
US

V. Phone/Fax

Practice location:
  • Phone: 520-797-3888
  • Fax: 520-797-2196
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number63219
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number304857-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: