Healthcare Provider Details

I. General information

NPI: 1598191868
Provider Name (Legal Business Name): GENEROSA SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 PALMETTO ST
CLEARWATER FL
33755-5056
US

IV. Provider business mailing address

1430 PALMETTO ST
CLEARWATER FL
33755-5056
US

V. Phone/Fax

Practice location:
  • Phone: 727-443-6010
  • Fax: 727-443-6010
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL8472
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberAL8472
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: