Healthcare Provider Details

I. General information

NPI: 1205497336
Provider Name (Legal Business Name): GERARDO DAVID RESTO SANTOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 DIAMOND CENTRE CT UNIT 1301
FORT MYERS FL
33912-4366
US

IV. Provider business mailing address

7421 RIDGE RD STE 105
PORT RICHEY FL
34668-6935
US

V. Phone/Fax

Practice location:
  • Phone: 727-888-9289
  • Fax: 727-306-8052
Mailing address:
  • Phone: 727-888-9289
  • Fax: 727-306-8052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME191761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: